TY - JOUR
T1 - Minimally invasive surgery for clinical T4 non-small-cell lung cancer
T2 - national trends and outcomes
AU - Rodriguez-Quintero, Jorge Humberto
AU - Elbahrawy, Mostafa M.
AU - Montal, Anne Michelle
AU - Jindani, Rajika
AU - Vimolratana, Marc
AU - Kamel, Mohamed K.
AU - Stiles, Brendon M.
AU - Chudgar, Neel P.
N1 - Publisher Copyright:
# The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - OBJECTIVES: Recent randomized data support the perioperative benefits of minimally invasive surgery (MIS) for non-small-cell lung cancer (NSCLC). Its utility for cT4 tumours remains understudied. We, therefore, sought to analyse national trends and outcomes of minimally invasive resections for cT4 cancers. METHODS: Using the 2010–2019 National Cancer Database, we identified patients with cT4N0-1 NSCLC. Patients were stratified by surgical approach. Multivariable logistic analysis was used to identify factors associated with use of a minimally invasive approach. Groups were matched using propensity score analysis to evaluate perioperative and survival end points. RESULTS: The study identified 3715 patients, among whom 64.1% (n ¼ 2381) underwent open resection and 35.9% (n ¼ 1334) minimally invasive resection [robotic-assisted in 31.5% (n ¼ 420); and video-assisted in 68.5% (n ¼ 914)]. Increased MIS use was noted among patients with higher income [≥$40 227, odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01–1.51] and those treated at academic hospitals (OR 1.25; 95% CI 1.07–1.45). Clinically node-positive patients (OR 0.68; 95% CI 0.55–0.83) and those who underwent neoadjuvant therapy (OR 0.78; 95% CI 0.65–0.93) were less likely to have minimally invasive resection. In matched groups, patients undergoing MIS had a shorter median length of stay (5 vs 6 days, P < 0.001) and no significant differences between 30-day readmissions or 30/90-day mortality. MIS did not compromise overall survival (log-rank P ¼ 0.487). CONCLUSIONS: Nationally, the use of minimally invasive approaches for patients with cT4N0-1M0 NSCLC has increased substantially. In these patients, MIS is safe and does not compromise perioperative outcomes or survival.
AB - OBJECTIVES: Recent randomized data support the perioperative benefits of minimally invasive surgery (MIS) for non-small-cell lung cancer (NSCLC). Its utility for cT4 tumours remains understudied. We, therefore, sought to analyse national trends and outcomes of minimally invasive resections for cT4 cancers. METHODS: Using the 2010–2019 National Cancer Database, we identified patients with cT4N0-1 NSCLC. Patients were stratified by surgical approach. Multivariable logistic analysis was used to identify factors associated with use of a minimally invasive approach. Groups were matched using propensity score analysis to evaluate perioperative and survival end points. RESULTS: The study identified 3715 patients, among whom 64.1% (n ¼ 2381) underwent open resection and 35.9% (n ¼ 1334) minimally invasive resection [robotic-assisted in 31.5% (n ¼ 420); and video-assisted in 68.5% (n ¼ 914)]. Increased MIS use was noted among patients with higher income [≥$40 227, odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01–1.51] and those treated at academic hospitals (OR 1.25; 95% CI 1.07–1.45). Clinically node-positive patients (OR 0.68; 95% CI 0.55–0.83) and those who underwent neoadjuvant therapy (OR 0.78; 95% CI 0.65–0.93) were less likely to have minimally invasive resection. In matched groups, patients undergoing MIS had a shorter median length of stay (5 vs 6 days, P < 0.001) and no significant differences between 30-day readmissions or 30/90-day mortality. MIS did not compromise overall survival (log-rank P ¼ 0.487). CONCLUSIONS: Nationally, the use of minimally invasive approaches for patients with cT4N0-1M0 NSCLC has increased substantially. In these patients, MIS is safe and does not compromise perioperative outcomes or survival.
KW - Lung cancer
KW - Minimally invasive surgery
KW - Robotic-assisted thoracoscopic surgery
KW - Thoracotomy
KW - Video-assisted thoracoscopic surgery
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U2 - 10.1093/ejcts/ezae009
DO - 10.1093/ejcts/ezae009
M3 - Article
C2 - 38263602
AN - SCOPUS:85185973568
SN - 1010-7940
VL - 65
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 3
M1 - ezae009
ER -