Document Detail


Safety and efficacy of video-assisted versus conventional lung resection for lung cancer.
MedLine Citation:
PMID:  19464458     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We sought to evaluate the use of video-assisted thoracoscopy among patients with lung cancer and its safety and effectiveness relative to conventional resection. METHODS: A cohort study (1994-2002) was conducted by using the Surveillance, Epidemiology, and End-Results Medicare database. Video-assisted thoracoscopy and conventional resection were hypothesized to be equivalent in terms of risks of death. Equivalency was defined by a confidence interval of 0.72 to 1.28 for the odds of 30-day death and 0.89 to 1.11 for the hazard of death, corresponding to a difference of no more than 1% for 30-day mortality and 5% for 5-year survival, respectively. RESULTS: Among 12,958 patients who underwent segmentectomy or lobectomy (mean age, 74 +/- 5 years), 6% underwent video-assisted thoracoscopy. The use of video-assisted thoracoscopy increased from 1% to 9% between 1994 and 2002. Compared with those who underwent conventional resection, patients who underwent video-assisted thoracoscopy more frequently had smaller tumors (P < .001) and stage I disease (P = .03), underwent lymphadenectomy (P < .001), and were cared for by higher-volume surgeons (P < .001) and at higher-volume hospitals (P < .001). After adjusting for differences in patient, cancer, management, and provider characteristics, the odds of early death were not significantly different between patients undergoing video-assisted thoracoscopy and those undergoing conventional resection, although equivalency was not demonstrated (adjusted odds ratio, 0.93; 95% confidence interval, 0.57-1.50). The hazard of death was equivalent for video-assisted thoracoscopy and conventional resection (adjusted hazard ratio, 0.99; 95% confidence interval, 0.90-1.08). CONCLUSIONS: Video-assisted thoracoscopy was uncommonly used to manage lung cancer, although its use has increased over time. Video-assisted thoracoscopy and conventional resection were equivalent in terms of long-term survival.
Authors:
Farhood Farjah; Douglas E Wood; Michael S Mulligan; Bahirathan Krishnadasan; Patrick J Heagerty; Rebecca Gaston Symons; David R Flum
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2009-03-09
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  137     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-25     Completed Date:  2009-06-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1415-21     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Wash 98195-6310, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Combined Modality Therapy
Female
Humans
Lung Neoplasms / mortality,  pathology,  surgery*
Male
Pneumonectomy* / methods
Survival Rate
Thoracic Surgery, Video-Assisted*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
F32 CA130434-01/CA/NCI NIH HHS; T32 CA09168-30/CA/NCI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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