Prognostic factors and recurrence dynamics after multiple-port video-assisted thoracoscopic lobectomy for clinical T1-3N0 non-small cell lung cancer

Background: The objectives of this study were to examine the outcomes, including early postoperative course, pathologic nodal upstaging, and long-term survival in patients who underwent video-assisted thoracoscopic surgery (VATS) lobectomy for clinical T1-3N0M0 non-small cell lung cancer (NSCLC) and to analyze the prognostic factors and recurrence dynamics in this cohort. Methods: Between January 2010 and December 2014, 1, 946 patients who underwent curative-intent VATS lobectomy for clinical T1-3N0M0 disease were recognized and their medical records were retrospectively reviewed to assess clinicopathologic characteristics, early postoperative outcomes, recurrence pattern, and survival. Results: The study included 987 men and 959 women with a mean age of 61 years. The most common histologic type was adenocarcinoma (87%). Preoperative staging workup revealed that all patients had clinical N0 disease. The mean number of harvested lymph nodes (LNs) was 16 (interquartile range, 11 to 21). Pathologic N1 and N2 diseases were finally confirmed in 123 (6.3%) and 146 patients (7.5%), respectively. On multivariable logistic regression analysis, higher clinical T category and 11 or more than 11 total harvested LNs were significant predictors of detecting unexpected pathologic N1 or N2 diseases. Two in-hospital mortalities (0.1%) and 441 complications (22.7%) occurred during the early postoperative period. The median follow-up time was 45 months. At the end of follow-up, there were 1, 728 surviving patients (88.8%). Overall survival at 5 years were 89.6% in pathologic N0, 76.5% in pathologic N1, and 61% in pathologic N2. During follow-up, 364 patients (18.7%) developed recurrence. The pattern of recurrence was loco-regional in 67 patients, distant in 226, and both in 71. Recurrence-free survival at 5 years were 81.7% in pathologic N0, 37.8% in pathologic N1, and 29.2% in pathologic N2. Conclusions: Our findings suggest that VATS lobectomy could result in acceptable long-term survival outcomes in clinical T1-3N0M0 NSCLC even when unexpected N1 or N2 involvement was detected postoperatively.