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Multicenter Study
. 2023 Jun 1;277(6):1002-1009.
doi: 10.1097/SLA.0000000000005820. Epub 2023 Feb 10.

Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study: Survival Analysis of 6646 Cases

Michael S Kent  1 , Matthew G Hartwig  2 , Eric Vallières  3 , Abbas E Abbas  4 , Robert J Cerfolio  5 , Mark R Dylewski  6 , Thomas Fabian  7 , Luis J Herrera  8 , Kimble G Jett  9 , Richard S Lazzaro  10 , Bryan Meyers  11 , Rishindra M Reddy  12 , Michael F Reed  13 , David C Rice  14 , Patrick Ross  15 , Inderpal S Sarkaria  16 , Lana Y Schumacher  17 , Lawrence N Spier  10 , William B Tisol  18 , Dennis A Wigle  19 , Michael Zervos  5
Affiliations
Multicenter Study

Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study: Survival Analysis of 6646 Cases

Michael S Kent et al. Ann Surg. .

Abstract

Objective: The aim of this study was to analyze overall survival (OS) of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS), and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions.

Summary background data: Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative data sets.

Methods: Retrospective data was collected from 21 institutions from 2013 to 2019. Consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting was used to balance baseline characteristics. OS was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors.

Results: A total of 2789 RL, 2661 VATS, and 1196 OL cases were included. The unadjusted 5-year OS rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P =0.008. Similar trends were also observed after inverse-probability of treatment weighting adjustment (RL 81%; VATS 73%, OL 85%, P =0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher OS compared with VATS (OL vs. VATS: hazard ratio=0.64, P <0.001 and RL vs. VATS: hazard ratio=0.79; P =0.007).

Conclusions: Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.

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Conflict of interest statement

A.E.A.: Consultant, Intuitive Surgical. R.J.C.: Consultant, Intuitive Surgical. M.R.D.: Consultant for Intuitive Surgical and Verb Surgical, Clinical Education Ethicon. L.J.H.: Consultant, Intuitive Surgical. K.G.J.: Consultant, Intuitive Surgical. M.S.K.: Speaker, Intuitive Surgical. R.M.R.: Consultant for Intuitive Surgical and Auris Health, Advisory Board Medtronic. P.R.: Consultant, Intuitive Surgical. I.S.S.: Consultant, Intuitive Surgical. L.Y.S.: Proctor, Intuitive Surgical. W.B.T.: Consultant, Intuitive Surgical. The remaining authors report no conflicts of interest.

References

    1. Whitson BA, Groth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted VATS surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg. 2008;86:2008–2016.
    1. Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009;27:2553–2562.
    1. Kent MS, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg. 2014;97:236–242.
    1. Oh DS, Reddy RM, Gorrepati ML, et al. Robotic-assisted, video-assisted VATS and open lobectomy: propensity-matched analysis of recent Premier data. Ann Thorac Surg. 2017;104:1733–1740.
    1. Howington JA, Blum MG, Chang AC, et al. Treatment of stage I and II non-small cell lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e278S–e313S.

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