Video-assisted thoracoscopic surgery (VATS) led to a 21% reduction in the risk of death compared with open lobectomy for patients with early-stage lung cancer, in a meta-analysis of randomized trials comparing the two approaches. Results of the meta-analysis were presented at the International Association for the Study of Lung Cancer (IASLC) 2025 World Conference on Lung Cancer (WCLC; Abstract PL03.13).
“For the first time, we provide evidence that a simple change in surgical access to VATS reduces the overall risk of death by 21% without any compromise to disease-free survival,” stated Jacie Jiaqi Law, Associate Surgical Specialty Lead in Thoracic Surgery, Royal Brompton Hospital, United Kingdom. “These results underscore the importance of prioritizing VATS when technically feasible as the access of choice for surgical resection of early-stage non–small cell lung cancer.”
Background and Study Methods
VATS has become the most common approach to performing pulmonary lobectomy in patients with early-stage lung cancer instead of the previously used open lobectomy due to reduced pain, fewer complications, faster recovery times, and improved quality-of-life with VATS. Previous studies of VATS vs open lobectomy have not been powered to detect overall survival or disease-free survival differences, leading to open questions about its oncologic benefits. Other meta-analyses of mostly nonrandomized studies have been limited by biases. As such, the researchers sound to identify randomized trials for a meta-analysis to answer whether VATS leads to oncologic benefits over open lobectomy in terms of overall and disease-free survival.
They conducted a systematic literature search for eligible trials, which were assessed for quality with the Cochrane risk-of-bias tool, and individual patient data. Three trials met the eligibility criteria among 556 potential studies, and these studies included 1,185 patients randomly assigned to undergo VATS (n = 586) or open lobectomy (n = 599). The three studies included in the meta-analysis were Bendixen et al from Denmark (ClinicalTrials.gov identifier NCT01278888), Long et al from China (NCT01102517), and Lim et al from the United Kingdom (NCT03521375). The risk of bias was low in all of these studies, and baseline characteristics were balanced between groups, with the possible exception of age.
Key Study Findings
The pooled hazard ratio for overall survival VATS vs open lobectomy was 0.79 (95% hazard ratio [HR] = 0.65–0.96). In terms of disease-free survival, the pooled hazard ratio was 0.91 (95% CI = 0.75–1.12). Sensitivity analyses that excluded patients with benign disease showed similar pooled hazard ratios of 0.78 for overall survival (95% CI = 0.64–0.95) and 0.89 for disease-free survival (95% CI = 0.73–1.09). Subgroup analysis showed that the treatment effect did not differ by age for overall survival (P = .83) or disease-free survival (P = .43).
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