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

Autor: Caso R; Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia., Watson TJ; Division of Thoracic Surgery, Department of Surgery, Beaumont Health, Detroit, Michigan., Tefera E; Department of Biostatistics and Biomedical Informatics, Medstar Health Research Institute, Washington, District of Columbia., Cerfolio R; Division of Thoracic Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York., Abbas AE; Division of Thoracic Surgery, Department of Surgery, Brown University, Providence, Rhode Island., Lazar JF; Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia., Margolis M; Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia., Hwalek AE; Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia., Khaitan PG; Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Khalifa University, Abu Dhabi, UAE. Electronic address: pkhaitan@ssmc.ae.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Apr; Vol. 296, pp. 674-680. Date of Electronic Publication: 2024 Feb 15.
DOI: 10.1016/j.jss.2024.01.028
Abstrakt: 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.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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