OBJECTIVE: Lung adenocarcinoma (NSCLC) is a common subtype of lung cancer, and its prevalence has gradually increased in recent years. There are various treatment methods for NSCLC, and surgical resection, as one of the important treatments, is crucial to improving the survival rate and quality of life of patients. To explore the effect and complications of video-assisted thoracic surgery (VATS) and radical thoracotomy for lung cancer (RTLC) in the treatment of stages IIB-IIIA non-small cell lung cancer (NSCLC).
METHODS: A total of 80 patients with NSCLC admitted to the hospital were enrolled between June 2019 and January 2021. According to the random number table method, they were divided into the VATS group (40 cases, VATS) and RTLC group (40 cases, RTLC). The operation time, intraoperative blood loss, postoperative drainage time, number of lymph node dissections, score of visual analogue scale (VAS) at 24 h after surgery, and hospitalization time were compared between the two groups. We chose specific inclusion criteria, including patients diagnosed with non-small cell lung cancer (NSCLC) who did not receive radiation therapy or chemotherapy before surgery, to ensure consistency and comparability across studies. We focused on indicators related to lung function and immune system, such as CD3+, CD4+ and CD8+ levels, as well as FEV1, FVC and MVV, to evaluate the impact of surgery on lung function and immune status. The levels of CD3+, CD4+, and CD8+ in both groups were detected by flow cytometry at 1 d before surgery and 3 d after surgery. The forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and maximal voluntary ventilation (MVV) in both groups were detected by spirometry before and at 1 month after surgery. The occurrence of postoperative complications in both groups was recorded. After 12 months of follow-up, survival rates in both groups were statistically analyzed. The progression-free survival (PFS) and 12-month overall survival (OS) in both groups were analyzed by the Kaplan-Meier method.
RESULTS: The incision length, operation time, intraoperative blood loss, postoperative drainage time, VAS score at 24 h after surgery, and hospitalization time in VATS group were significantly lower than those in RTLC group (P < .05). The two groups had no significant difference in the number of lymph node dissections (P > .05). At 3 d after surgery, levels of CD3+, CD4+ and CD8+ in VATS group were significantly higher than those in RTLC group (P < .05). At 1 month after surgery, FEV1, FVC, and MVV in VATS group operation were significantly higher than those in RTLC group (P < .05). The incidence of postoperative complications in VATS group was lower than that in RTLC group (5.00% vs. 20.00%) (P < .05). Kaplan-Meier survival analysis showed that there was no significant difference in 12-month OS or PFS between the two groups (P > .05).
CONCLUSIONS: The long-term curative effect of VATS and RTLC is comparable on patients with stages IIB-IIIA NSCLC. The former has advantages such as less surgical injury, faster postoperative recovery, and higher safety, which can reduce the incidence of postoperative complications. This study provides clinicians with important information about the treatment of stage IIb ~ IIIa NSCLC and helps them choose surgical methods more wisely. These results also alert physicians to focus on operative time, blood loss, and complication risk to maximize patient outcomes.