No Survival Benefit for Minimally Invasive Pneumonectomy Over Open Surgery in Lung Cancer Patients, Study Finds

For this purpose, the researchers queried patients who underwent pneumonectomy for NSCLC between 2015 and 2020 from the National Cancer Database. The surgical approaches were classified into robot-assisted (RATS), video-assisted thoracoscopic (VATS), and open pneumonectomy.

Propensity score matching was employed to ensure balanced patient cohorts. Both univariate and multivariate regression analyses were conducted to explore the relationship between surgical approach and 30- and 90-day mortality, while a Cox proportional hazards model was utilized to evaluate overall survival.

The study led to the following findings:

• 3784 patients were identified, including 73% open, 19% VATS, and 8% RATS.
• The overall conversion rate from minimally invasive to open was 29.5%.
• After propensity matching 212 patients per cohort, there were no differences between open, VATS, and RATS 30-day (9.4% versus 8.5% versus 7.5%, respectively) or 90-day mortality (14.2% versus 12.3% versus 10.4%, respectively).
• Median overall survival was similar among open (48 months), VATS (51.0 months), and RATS approaches (50 months).
• On multivariate analysis of the matched cohort, there was no association between approach and overall survival.
• RATS (OR 0.67) and neoadjuvant chemotherapy (OR 0.52) were protective against conversion to open.

"The findings showed that minimally invasive pneumonectomy can achieve short-term and long-term survival rates comparable to those of open pneumonectomy," the researchers concluded.

Reference:

Shah, S. K., Khan, A. A., Basu, S., & Seder, C. W. (2024). Minimally Invasive Pneumonectomy vs Open Pneumonectomy: Outcomes and Predictors of Conversion. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2024.07.027