PURPOSE: Literature reviews generally support the use of VATS lobectomy compared to open thoracotomy/lobectomy for the treatment of early stage non-small cell lung cancer (NSCLC). We used established criteria to grade the clinical evidence and determine the strength of the recommendations for the use of VATS lobectomy.
METHODS: We performed a systematic review of the MEDLINE database from 1960 through January, 2008. Relevant articles were selected and references searched for other articles. We included randomized clinical trials (RCTs) and relevant case-control studies and all case series of at least 100 patients. We graded articles using the method of the American College of Chest Physicians (ACCP) Evidence-Based Lung Cancer Guidelines (2nd Ed) and the National Cancer Institute (NCI) format. We also evaluated RCTs using the Consolidated Standards of Reporting Trials (CONSORT) checklist.
RESULTS: We evaluated 4 RCTs, 12 case-control series and 11 cases series. Two of four RCTs were excluded (one had no clinical endpoint, one compared VATS to assisted VATS), two were analyzed [Table 1]. Both were small studies (n=61–100)with moderate/high evidence quality (ACCP)or level 1ii (NCI). Both studies had 5–6 deficiencies as measured by CONSORT standards. 11/12 case-control series were considered evidence grade 2 (NCI) or of moderate / low evidence quality (ACCP). One had an imbalance in the control group. The 11 case series were considered evidence grade 3i (NCI) or low quality evidence (ACCP). Similar lymph node removal for VATS compared to open thoracotomy was reported by 2RCTs and 2 case-control series. Decreased length of stay was reported in 0 RCTs and 3 case-control series. Improved quality of life with VATS lobectomy was noted in 3 case-control series.
CONCLUSION: Recommendations for the use of VATS lobectomy to treat patients with clinical stage I NSCLC are generally based on moderate or low grade evidence.
CLINICAL IMPLICATIONS: A larger, multicenter, randomized clinical trial comparing the two approaches or case-control series using sophisticated statistical methods (propensity-scoring, regression adjustment) would provide stronger evidence upon which to make clinical recommendations.
DISCLOSURE: Walter Scott, No Financial Disclosure Information; No Product/Research Disclosure Information