VATS lobectomy improves overall survival vs open surgery in early-stage NSCLC

This individual patient data meta-analysis of randomized controlled trials provides evidence on the oncological outcomes of video-assisted thoracoscopic surgery (VATS) versus open lobectomy for early-stage non-small-cell lung cancer. The analysis systematically reviewed literature from January 1, 2000, to June 13, 2025, and included three eligible randomized trials that compared VATS with open lobectomy performed after 2000 in adults aged 18 years or older with clinical early-stage NSCLC. Individual patient data were obtained for 1185 patients, with 586 randomized to VATS and 599 to open lobectomy. The primary outcome was overall survival, analyzed using a one-stage random effects Cox proportional hazards model, with a two-stage approach performed to assess consistency. Risk of bias was assessed using the Cochrane risk of bias tool for randomized trials. The analysis found that overall survival favored VATS lobectomy, with a pooled hazard ratio of 0.79 (95% CI 0.65-0.96), reflecting a 21% mortality risk reduction. For the secondary outcome of disease-free survival, the pooled hazard ratio was 0.91 (95% CI 0.75-1.12), indicating no significant difference between the two surgical approaches. There was no evidence of statistical heterogeneity across the included trials for either survival outcome. The authors interpret these findings as evidence that VATS lobectomy improves overall survival compared with open surgery without compromising disease-free survival. The study was funded by the National Institute for Health and Care Research.

When you need surgery for early-stage lung cancer, you want the approach that gives you the best shot at a long life. For years, doctors have known that a less invasive surgery called VATS (video-assisted thoracoscopic surgery) typically means less pain and a faster recovery than traditional open surgery. But a big question remained: does it also help people live longer? A new analysis combining data from three major studies finally provides an answer. The analysis looked at nearly 1,200 patients. It found that people who had the VATS procedure had a 21% lower risk of dying from any cause compared to those who had open surgery. When it came to cancer coming back, there was no real difference between the two groups—both approaches were equally effective at keeping the cancer at bay. This is important because it shows that the less invasive surgery isn't just about a better recovery; it's also linked to better long-term survival. The researchers conclude that when it's technically possible, VATS should be the preferred choice for removing early-stage lung cancer.