Outcomes following minimally invasive approaches vs. open extended lobectomy for non-small cell lung cancer: a propensity-matched analysis of the National Cancer Database

Abstract

Background: Traditional thoracotomy, an invasive surgical procedure, has been the standard approach for extended lobectomy in treating non-small cell lung cancer (NSCLC). However, minimally invasive surgery (MIS) has gained traction with advancements in surgical techniques. Despite this, the outcomes of extended lobectomy via a minimally invasive approach remain largely uncharted. Using the comprehensive National Cancer Database (NCDB), our research aimed to clarify the safety, feasibility, and efficacy of minimally invasive extended lobectomy in patients diagnosed with NSCLC.

Methods: Our study encompassed a selection of patients with NSCLC who underwent extended lobectomy (defined as lobectomy or bilobectomy with chest wall, diaphragm or pericardial resection) between 2010 and 2014. Through propensity score matching (PSM), we ensured a balanced comparison between patients who underwent MIS and those who opted for the traditional open extended lobectomy. Both univariate and multivariate analyses were employed to discern whether the surgical approach had any significant impact on the prognosis of patients undergoing this specific procedure.

Results: Before PSM, our dataset included 3,934 patients. After 1:2 PSM, the MIS group included 683 cases, while the open group included 1,317 cases. One notable finding was the reduced average postoperative hospital stay for the MIS group at 7.15 days compared to the open group at 8.40 days (P<0.001). Furthermore, the 5-year survival rate was similar, with the MIS group at 53.1% and the open group at 51.3% (P=0.683).

Conclusions: The results of our study suggest that MIS for extended lobectomy not only is safe and feasible but also is oncologically effective. However, it is imperative to note that these encouraging findings necessitate further validation through prospective studies to ascertain the full scope of benefits and potential risks associated with MIS.

Keywords: National Cancer Database (NCDB); Non-small cell lung cancer (NSCLC); extended lobectomy; minimally invasive surgery (MIS).

Figure 1

Study population flow diagram of NSCLC patients in NCDB who underwent extended lobectomy between 2010 and 2014. The content at the bottom right explains what these surgery codes mean here. NCDB, National Cancer Database; NSCLC, non-small cell lung cancer; MIS, minimally invasive surgery; NOS, not otherwise specified.

Figure 2

Annual numbers and perioperative results of patients undergoing extended lobectomy. (A) Annual numbers, MIS rates, and conversion rates of patients undergoing extended lobectomy. (B) Annual data for cT3 + cT4 stage and cN1 + cN2 stage patients undergoing MIS extended lobectomy. (C) Annual data for mean lymph nodes harvested and mean postoperative LOS of patients undergoing MIS extended lobectomy. (D) Annual readmission rates, 30-day mortality, and 90-day mortality of patients undergoing MIS extended lobectomy. MIS, minimally invasive surgery; LN, lymph node; LOS, length of stay.

Figure 3

Overall survival curves for extended lobectomy in different groups. (A) Comparison of overall survival between the open group and MIS group (unmatched). (B) Comparison of overall survival between the open group and MIS group (matched). (C) Comparison of overall survival between the open group and conversion group (matched). (D) Comparison of overall survival between the open and MIS groups in the community/comprehensive community cancer program cohort (matched). MIS, minimally invasive surgery.