Nodal Upstaging Is More Common with Thoracotomy than with VATS During Lobectomy for Early-Stage Lung Cancer: An Analysis from the National Cancer Data Base

• Type of Material: Article
• Authors: Rachel L. Medbery, Emory University; Theresa Gillespie, Emory University; Yuan Liu, Emory University; Dana C Nickleach, Emory University; Joseph Lipscomb, Emory University; Manu Sancheti, Emory University; Allan Pickens, Emory University; Seth Force, Emory University; Felix Fernandez, Emory University
• Language: English
• Date: 2016-02-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jtho.2015.10.007
• Title of Journal or Parent Work: Journal of Thoracic Oncology
• ISSN: 1556-0864
• Volume: 11
• Issue: 2
• Start Page: 222
• End Page: 233
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: EXPERIENCE; Staging; Video-assisted thoracic surgery (VATS); LONG-TERM SURVIVAL; Respiratory System; PROPOSALS; THORACOSCOPIC LOBECTOMY; LOWER MORBIDITY; Science & Technology; Life Sciences & Biomedicine; Oncology; FORTHCOMING 7TH EDITION; Lung cancer surgery; PROPENSITY SCORE METHODS; TNM CLASSIFICATION; ASSISTED THORACIC-SURGERY; Lobectomy; GUIDELINES 2ND EDITION
• Research Categories: Biology, Biostatistics; Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Introduction Questions remain regarding nodal evaluation and upstaging between thoracotomy (open) and Video Assisted Thoracic Surgery (VATS) approaches to lobectomy for early stage lung cancer. Potential differences in nodal staging based on operative approach remains as the final significant barrier to widespread adoption of VATS lobectomy. The current study examines differences in nodal staging between open and VATS lobectomy. Methods The National Cancer Data Base was queried for lung cancer patients with clinical stage ≤T2N0M0 who underwent lobectomy in 2010-2011. Propensity score matching was performed to compare rate of nodal upstaging in VATS vs. open approaches. Additional sub-group analysis was performed to assess whether or not rates of upstaging differed by specific clinical settings. Results A total of 16,983lobectomies were analyzed; 4935 (29.1%) were performed via VATS. Nodal upstaging was more frequent in the open group (12.8 vs. 10.3%; p<0.001). In 4,437 matched pairs, nodal upstaging remained more common for open approaches. For a sub-group of patients whose number of lymph nodes examined was ≥7, propensity matching revealed that nodal upstaging remained more common following open vs. VATS (14.0 vs. 12.1%; p=0.03). However, for patients who were treated in an Academic/Research Facility, the difference in nodal upstaging was no longer significant between an open vs. VATS approach (12.2 vs. 10.5%, p=0.08). Conclusions Nodal upstaging was more frequently observed with thoracotomy compared to VATS for early stage lung cancer. However, nodal upstaging appears to be impacted by facility type, which may represent a surrogate for minimally invasive expertise.