Clinical efficacy and safety of video-assisted thoracoscopic lobectomy versus wedge resection in elderly patients with early-stage non-small cell lung cancer.

OBJECTIVE: To compare the clinical efficacy and safety of video-assisted thoracoscopic surgery (VATS) lobectomy and VATS wedge resection in elderly patients with early-stage non-small cell lung cancer (NSCLC).

METHODS: A retrospective analysis was conducted on the clinical data of 156 elderly patients with early-stage NSCLC who underwent surgical treatment at our hospital between January 2019 and December 2023. According to the surgical procedure, the patients were divided into a lobectomy group (n = 88) and a wedge resection group (n = 68). Perioperative outcomes, inflammatory markers, changes in pulmonary function, tumor marker levels, postoperative complications, quality of life, and survival outcomes were compared between the two groups.

RESULTS: There were no statistically significant differences in baseline characteristics between the two groups (P > 0.05). Compared with the lobectomy group, the wedge resection group had less intraoperative blood loss, shorter postoperative drainage duration, lower drainage volume, and shorter hospital stay, and all these differences were statistically significant (P < 0.001), whereas operative time was comparable between the two groups (P > 0.05). Serum C-reactive protein (CRP) and procalcitonin (PCT) levels on postoperative days 1 and 3 were significantly increased in both groups compared with preoperative levels, but the increase was significantly smaller in the wedge resection group. At 3 months after surgery, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and maximal voluntary ventilation (MVV) were all decreased in both groups compared with preoperative values, but the decline was less pronounced in the wedge resection group (P < 0.001). Postoperative tumor marker levels, including carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1), were reduced in both groups compared with pretreatment levels, but no significant differences were found between the groups (P > 0.05). The overall incidence of postoperative complications was lower in the wedge resection group than in the lobectomy group (4.41% vs. 12.50%), although the difference was not statistically significant (P > 0.05). Survival analysis was exploratory only and limited by the small number of events and relatively short follow-up duration; therefore, no definitive conclusions can be drawn (P > 0.05). At 12 months after surgery, quality-of-life scores in physical functioning, role functioning, and emotional functioning were significantly higher in the wedge resection group than in the lobectomy group (P < 0.001). Multivariate logistic regression analysis showed that TNM stage was an independent risk factor for poor prognosis in elderly patients with early-stage NSCLC (OR = 6.087, P = 0.001), whereas age ≤ 70 years was independently associated with a better prognosis (OR = 0.135, P < 0.001). A nomogram prediction model was further established based on these variables, and the area under the receiver operating characteristic curve (AUC) was 0.810, indicating good predictive performance.

CONCLUSION: Both VATS lobectomy and VATS wedge resection are safe and effective surgical options for elderly patients with early-stage NSCLC. Wedge resection shows certain advantages in reducing perioperative trauma, alleviating inflammatory response, preserving pulmonary function, and improving postoperative quality of life, whereas no statistically significant difference was observed between the two procedures in short-term oncological outcomes or survival prognosis. TNM stage and age were independent prognostic factors. The prediction model constructed based on these two variables may have good clinical value for individualized prognostic assessment in elderly patients with early-stage NSCLC.