Video-Assisted Thoracoscopic Sleeve Lobectomy Versus Open Approach in Non-Small Cell Lung Cancer: A Single-Center Study with Propensity Score Matching

Aim: It was aimed to compare the outcomes of sleeve lobectomy with video-assisted thoracoscopic surgery (VATS) and thoracotomy in patients with centrally located non-small cell lung cancer (NSCLC). Materials and Methods: Between January 2020 and February 2024, 127 patients who underwent sleeve lobectomy for NSCLC were retrospectively analyzed. Thoracotomy was used in 105 (82.6%) sleeve lobectomy cases while VATS was used in 22 (17.4%) cases. Subgroups were created according to pathology stages using propensity score analysis. Both groups were compared in terms of perioperative and early postoperative complications. Results: No significant differences were found between the thoracotomy and VATS groups in operation time or perioperative bleeding (4.3±0.9 hours vs 4.5±0.9, 467±385 mL vs 370±70 mL, p=0.474, 0.525, respectively). However, drainage time and hospital stay were significantly shorter in the VATS group (4.5±4 days vs 3.6±3.3 days, 7.1±7.9 days vs 5.1±3.4 days, respectively, (p=0.014, 0.005). In terms of oncological principles, there was no statistically significant difference between the groups regarding the number of sampled lymph nodes, pathological tumor sizes, pathological stages, and histopathological cell types (p=0.349, 0.106, 0.709, 0.066, respectively). There was no significant difference between the groups in terms of early postoperative complications (30.5% vs 40.9%, p: 0.341). After propensity score analysis, it was found that the VATS group had shorter drainage and hospital stay (p=0.023, 0.043, respectively). Conclusion: In NSCLC cases, sleeve lobectomies performed with the VATS approach are superior to open surgery with shorter drainage times and hospital stays without compromising oncological principles.