Thoracoscopic versus open surgery following neoadjuvant chemoradiation for clinical N2 lung cancer

Objective We evaluated the feasibility of video-assisted thoracoscopic surgery (VATS) following neoadjuvant concurrent chemoradiotherapy (nCCRT) for N2 non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed patients with clinical N2 NSCLC who underwent lobectomy and lymph node dissection after nCCRT. The patients were matched using a propensity score based on age, sex, pulmonary function test, histologic type, clinical T factor and method of N-staging. Results A total of 385 patients were enrolled between June 2012 and July 2017 (35 VATS; 350 open). After propensity matching (31 VATS, 112 open), the VATS group showed a significantly lower major complication rate (≥ grade II Clavien-Dindo classification; 9.7% vs 30.4%, P = .036). No significant differences were found between two group of 5-year survival rates (77.1 % for the VATS group, 59.9% for the open group; P = .276) and recurrence-free survival rates (66.3% for the VATS group, 54.6 % for the open group; P = .354). In multivariable analysis, VATS did not affect overall survival and recurrence-free survival. Conclusions VATS was comparable to open thoracotomy in patients with clinical N2 NSCLC after nCCRT without compromising oncologic efficacy.