Comparing Robotic, Thoracoscopic, and Open Segmentectomy: A National Cancer Database Analysis.

Authors

Raul Caso
Thomas J. Watson, Corewell Health
Eshetu Tefera
Robert Cerfolio
Abbas E Abbas
John F Lazar
Marc Margolis
Ann E Hwalek
Puja Gaur Khaitan

Document Type

Article

Publication Date

4-2024

Publication Title

Journal of Surgical Research

Abstract

INTRODUCTION: Minimally invasive approaches to lung resection have become widely acceptable and more recently, segmentectomy has demonstrated equivalent oncologic outcomes when compared to lobectomy for early-stage non-small cell lung cancer (NSCLC). However, studies comparing outcomes following segmentectomy by different surgical approaches are lacking. Our objective was to investigate the outcomes of patients undergoing robotic, video-assisted thoracoscopic surgery (VATS), or open segmentectomy for NSCLC using the National Cancer Database.

METHODS: NSCLC patients with clinical stage I who underwent segmentectomy from 2010 to 2016 were identified. After propensity-score matching (1:4:1), multivariate logistic regression analyses were performed to determine predictors of 30-d readmissions, 90-d mortality, and overall survival.

RESULTS: 22,792 patients met study inclusion. After matching, approaches included robotic (n = 2493; 17%), VATS (n = 9972; 66%), and open (n = 2493; 17%). An open approach was associated with higher 30-d readmissions (7% open versus 5.5% VATS versus 5.6% robot, P = 0.033) and 90-d mortality (4.4% open versus 2.2% VATS versus 2.5% robot, P < 0.001). A robotic approach was associated with improved 5-y survival (50% open versus 58% VATS versus 63% robot, P < 0.001).

CONCLUSIONS: For patients with clinical stage I NSCLC undergoing segmentectomy, compared to the open approach, a VATS approach was associated with lower 30-d readmission and 90-d mortality. A robotic approach was associated with improved 5-y survival compared to open and VATS approaches when matched. Additional studies are necessary to determine if unrecognized covariates contribute to these differences.

Volume

296

First Page

674

Last Page

680

Recommended Citation

Caso R, Watson TJ, Tefera E, Cerfolio R, Abbas AE, Lazar JF, Margolis M, Hwalek AE, Khaitan PG. Comparing robotic, thoracoscopic, and open segmentectomy: a National Cancer Database analysis. J Surg Res. 2024 Apr;296:674-680. doi: 10.1016/j.jss.2024.01.028. Epub 2024 Feb 15. PMID: 38359682.

DOI

10.1016/j.jss.2024.01.028

ISSN

1095-8673

PubMed ID

38359682