Has the time come to declare video-assisted thoracic surgery lobectomy the standard of care for early stage lung cancer?

In the absence of a well-designed randomized trial, propensity-matched studies are often viewed as the next best level of evidence to guide patient management. Overwhelmingly, published propensity-matched studies from large national databases have all shown the video-assisted thoracic surgery (VATS) approach to be superior to thoracotomy for lobectomy in the surgical treatment of lung cancer. Propensity-matched studies using the Society of Thoracic Surgeons (STS) database (1,2), the American College of Surgeons Oncology Group (ACOSOG) Z0030 study database (3), the American College of Surgeons National Surgical Quality Improvement Program database (4), the Nationwide Inpatient Sample database (5), the surveillance epidemiology and end results (SEER)-medicare database (6), the cancer and leukemia group B (CALGB) 140202 study database (7), the European Society of Thoracic Surgeon database (8), the Premier Prospective Database (9), the French National Database (10), and the National Cancer Data Base (NCDB) (11) have all uniformly shown VATS lobectomy have a lower complication rate and a shorter length of hospital stay when compared with lobectomy by thoracotomy. The current study by Zhao et al. (12) adds to this growing list of published propensity-matched studies that find the VATS approach to be superior.