A National Analysis of Minimally Invasive vs Open Segmentectomy for Stage IA Non-small-cell Lung Cancer.

Kumar, Arvind; Deng, John; Raman, Vignesh; Okusanya, Olugbenga; Baiu, Ioana; Berry, Mark F; D'Amico, Thomas A; Yang, Chi-Fu Jeffrey

The objective of this study was to compare long-term outcomes of open versus minimally invasive (MIS) segmentectomy for early stage non-small-cell lung cancer (NSCLC), which has not been evaluated using national studies. Outcomes of open versus MIS segmentectomy for clinical T1, N0, M0 NSCLC in the National Cancer Data Base (2010-2015) were evaluated using propensity score matching. Of the 39,351 patients who underwent surgery for stage IA NSCLC from 2010-2015, 770 underwent segmentectomy by thoracotomy and 1,056 by MIS approach (876 thoracoscopic [VATS], 180 robotic). The MIS to open conversion rate was 6.7% (n=71). After propensity-score matching, all baseline characteristics were well-balanced between the open (n=683) and MIS (n=683) groups. When compared to the open group, the MIS group had shorter median length of stay (LOS) (4 vs 5 days, p<0.001) and lower 30-day mortality (0.6% vs 1.9%, p=0.037). There were no significant differences between MIS and open groups with regard to 30-day readmission (5.0% vs 3.7%, p=0.43), or upstaging from cN0 to pN1/N2/N3 (3.1% vs 3.6%, p=0.89). The MIS approach was associated with similar long-term overall survival as the open approach (5-year survival: 62.3% vs 63.5%, p=0.89; multivariable-adjusted HR: 0.99, 95% CI: 0.82-1.21, p=0.96). In this national analysis of open versus MIS segmentectomy for clinical stage IA NSCLC, MIS was associated with shorter LOS and lower perioperative mortality, and similar nodal upstaging and 5-year survival when compared to segmentectomy via thoracotomy. MIS segmentectomy does not appear to compromise oncologic outcomes for clinical stage IA NSCLC.