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. 2024 Mar 1;65(3):ezae009.
doi: 10.1093/ejcts/ezae009.

Minimally invasive surgery for clinical T4 non-small-cell lung cancer: national trends and outcomes

Jorge Humberto Rodriguez-Quintero  1 , Mostafa M Elbahrawy  1 , Anne Michelle Montal  1 , Rajika Jindani  1 , Marc Vimolratana  1 , Mohamed K Kamel  2 , Brendon M Stiles  1 , Neel P Chudgar  1
Affiliations

Minimally invasive surgery for clinical T4 non-small-cell lung cancer: national trends and outcomes

Jorge Humberto Rodriguez-Quintero et al. Eur J Cardiothorac Surg. .

Abstract

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 = 2381) underwent open resection and 35.9% (n = 1334) minimally invasive resection [robotic-assisted in 31.5% (n = 420); and video-assisted in 68.5% (n = 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 = 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.

Keywords: Lung cancer; Minimally invasive surgery; Robotic-assisted thoracoscopic surgery; Thoracotomy; Video-assisted thoracoscopic surgery.

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Figures

Figure 1:
Figure 1:
Consort diagram of factors for selection of study cohort.
Figure 2:
Figure 2:
Increased use of minimally invasive surgery over time.
Figure 3:
Figure 3:
Standardized mean differences of the adjusted variables before and after propensity score matching. SMD: standardized mean differences.
Figure 4:
Figure 4:
Overall survival in propensity-matched groups.
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