Patients who underwent video-assisted thoracoscopic surgery (VATS) compared to open lobectomy had a significantly improved overall survival rate, according to a meta-analysis presented at the International Association for the Study of Lung Cancer (IASLC) 2025 World Conference on Lung Cancer (WCLC).

Video-assisted thoracoscopic surgery (VATS) is currently the most common approach to perform pulmonary lobectomy in early-stage lung cancer.

Advantages include reduced pain, fewer complications, faster recovery and improved quality-of-life.

The adoption of VATS lobectomy is based on proven non-oncological benefits.

According to Dr. Jacie Jiaqi Law, Royal Brompton Hospital, United Kingdom, none of the three largest contemporary randomised trials completed have been powered to detect a difference in overall or disease-free survival.

Several meta-analyses of predominantly non-randomised studies have suggested a VATS approach leads to improved patient survival compared to thoracotomy, however findings are limited due to selection bias and confounding, Dr. Law reported.

To answer this important question, Dr. Law and fellow researchers sought to identify randomised trials comparing VATS and open lobectomy in early-stage lung cancer and obtain individual patient data from these trials to conduct a meta-analysis.

Of the 556 potential studies identified, only three were randomised trials that met the eligibility criteria: Bendixen et al.

from Denmark (NCT01278888), Long et al. from China (NCT01102517) and Lim et al. from the United Kingdom (NCT03521375).

Data on 1185 patients (586 randomised to VATS and 599 randomised to open lobectomy) was provided from the three trials.

The primary analysis indicated significantly improved overall survival for patients randomised to VATS compared to open lobectomy, pooled hazard ratio (HR) 0.79 (95% confidence interval (CI) 0.65-0.96), representing a 21% reduction in the risk of death in the VATS lobectomy group. There was no difference in disease-free survival, pooled HR 0.91 (95% CI 0.75-1.12).

“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,” Dr. Law reported.

“These results underscore the importance of prioritising VATS when technically feasible as the access of choice for surgical resection of early-stage non-small cell lung cancer.”

Source: International Association for the Study of Lung Cancer