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. 2024 Jan 22;10(1):00653-2023.
doi: 10.1183/23120541.00653-2023. eCollection 2024 Jan.

Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients

Harry Etienne  1 , Pierre-Benoît Pagès  2 , Jules Iquille  1 , Pierre Emmanuel Falcoz  3 , Laurent Brouchet  4 , Jean-Philippe Berthet  5 , Françoise Le Pimpec Barthes  6 , Jacques Jougon  7 , Marc Filaire  8 , Jean-Marc Baste  9   10 , Valentine Anne  11 , Stéphane Renaud  12 , Thomas D'Annoville  13 , Jean Pierre Meunier  14 , Christophe Jayle  15 , Christian Dromer  16 , Agathe Seguin-Givelet  17 , Antoine Legras  18 , Philippe Rinieri  19 , Sophie Jaillard-Thery  20 , Vincent Margot  21 , Pascal-Alexandre Thomas  22 , Marcel Dahan  4 , Pierre Mordant  1
Affiliations

Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients

Harry Etienne et al. ERJ Open Res. .

Abstract

Introduction: Non-small cell lung cancer (NSCLC) is often associated with compromised lung function. Real-world data on the impact of surgical approach in NSCLC patients with compromised lung function are still lacking. The objective of this study is to assess the potential impact of minimally invasive surgery (MIS) on 90-day post-operative mortality after anatomic lung resection in high-risk operable NSCLC patients.

Methods: We conducted a retrospective multicentre study including all patients who underwent anatomic lung resection between January 2010 and October 2021 and registered in the Epithor database. High-risk patients were defined as those with a forced expiratory volume in 1 s (FEV1) or diffusing capacity of the lung for carbon monoxide (DLCO) value below 50%. Co-primary end-points were the impact of risk status on 90-day mortality and the impact of MIS on 90-day mortality in high-risk patients.

Results: Of the 46 909 patients who met the inclusion criteria, 42 214 patients (90%) with both preoperative FEV1 and DLCO above 50% were included in the low-risk group, and 4695 patients (10%) with preoperative FEV1 and/or preoperative DLCO below 50% were included in the high-risk group. The 90-day mortality rate was significantly higher in the high-risk group compared to the low-risk group (280 (5.96%) versus 1301 (3.18%); p<0.0001). In high-risk patients, MIS was associated with lower 90-day mortality compared to open surgery in univariate analysis (OR=0.04 (0.02-0.05), p<0.001) and in multivariable analysis after propensity score matching (OR=0.46 (0.30-0.69), p<0.001). High-risk patients operated through MIS had a similar 90-day mortality rate compared to low-risk patients in general (3.10% versus 3.18% respectively).

Conclusion: By examining the impact of surgical approaches on 90-day mortality using a nationwide database, we found that either preoperative FEV1 or DLCO below 50% is associated with higher 90-day mortality, which can be reduced by using minimally invasive surgical approaches. High-risk patients operated through MIS have a similar 90-day mortality rate as low-risk patients.

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Conflict of interest statement

Conflict of interest statement: The statistical analysis in this work was financially supported by the Marc Laskar grant. J-M. Baste and P-B. Pagès receive consulting fees from Medtronic and from Intuitive Surgical. P-A. Thomas is a consultant for Ethicon Endosurgery, AstraZeneca and Europrisme. A. Seguin-Givelet is a speaker for AstraZeneca and Medtronic. H. Etienne, J. Iquille, P.E. Falcoz, L. Brouchet, J-P. Berthet, F. Le Pimpec Barthes, J. Jougon, M. Filaire, V. Anne, S. Renaud, T. D'Annoville, J.P. Meunier, C. Jayle, C. Dromer, A. Legras, P. Rinieri, S. Jaillard, V. Margot, M. Dahan and P. Mordant have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

FIGURE 1
FIGURE 1
Study flowchart. VATS: video-assisted thoracic surgery; RATS: robotic-assisted thoracic surgery.
FIGURE 2
FIGURE 2
90-day mortality rate by risk group and year.
FIGURE 3
FIGURE 3
Survival curves during the first 90 days according to risk group.
FIGURE 4
FIGURE 4
Receiver operating characteristic of different models to predict 90-day mortality of high-risk patients. AUC: area under the curve.
See this image and copyright information in PMC

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