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Author Notes:

Corresponding Author: Felix G. Fernandez MD, MSc, The Emory Clinic, Suite A2214, 1365 Clifton Road, NE, Atlanta, Georgia 30322, Office: 404 778-1108, Fax: 404 778-4346, Email: felix.fernandez@emoryhealthcare.org

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The data used in the study are derived from a de-identified NCDB file.

The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used, or the conclusions drawn from these data by the investigator.

The authors have no financial disclosures.

Subjects:

Research Funding:

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:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Respiratory System
  • Lung cancer surgery
  • Lobectomy
  • Staging
  • Video-assisted thoracic surgery (VATS)
  • ASSISTED THORACIC-SURGERY
  • PROPENSITY SCORE METHODS
  • FORTHCOMING 7TH EDITION
  • GUIDELINES 2ND EDITION
  • LONG-TERM SURVIVAL
  • THORACOSCOPIC LOBECTOMY
  • TNM CLASSIFICATION
  • LOWER MORBIDITY
  • EXPERIENCE
  • PROPOSALS

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

Tools:

Journal Title:

Journal of Thoracic Oncology

Volume:

Volume 11, Number 2

Publisher:

, Pages 222-233

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2015 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

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