A. Kumar1, H. Devishetty1, T. Demmy1, S. Yendamuri1 1Roswell Park Cancer Institute,Department Of Thoracic Surgery,Buffalo, NY, USA
Introduction:
Over the last decade minimally invasive surgery has been increasingly liberally utilized for the treatment of non-small cell lung cancer (NSCLC). This approach is increasingly used for the conduct of pneumonectomies. We sought to examine short and long term outcomes of the use of minimally invasive surgery for pneumonectomy in the United States.
Methods:
The National Cancer Database was queried for patients undergoing pneumonectomy between 2004 and 2014 and trends examined. As coding for surgical approach is only available from 2010 onwards, this subset was examined for the impact of surgical approach on short and long term outcomes of minimally invasive pneumonectomy. Univariate and multivariate analyses were performed to examine the impact of surgical approach using SPSS.
Results:
18,926 patients had a pneumonectomy between 2004 and 2014. The proportion of patients having a pneumonectomy steadily declined from 9.1% to 4.9% of all anatomic resections over this time period. From 2010 to 2014, 7407 pneumonectomies were performed. 2.0% and 13.5% of these cases were attempted to be performed robot-assisted and by VATS respectively and 1.4% and 8.5% were completed as intended. Intent to treat analysis did not show a difference between minimally invasive (MIS) and open approaches with respect to 30 day and 90 day mortality (6.7% vs 7.0%; P=0.90 and 11.7 vs 12.4%; P=0.51 respectively). There were no differences in age, gender, race, stage, laterality, length of stay and readmission rates between both approaches. Of note, there was no difference in the number of lymph nodes examined between both approaches (21.4 vs 21.9; P=0.56). However, overall survival was higher in patients undergoing MIS pneumonectomy vs. open pneumonectomy in univariable (57 months vs. 40 months; P=0.013) and multivariable analyses (Figure 1).
Conclusion:
Minimally invasive pneumonectomy appears safe with peri-operative outcomes comparable to open surgery. MIS may improve long term pneumonectomy outcomes but confirmation by controlled studies is needed to reduce biases like high conversion and declining utilization rates observed in our cohort.
