Trends and factors affecting approach choice to pulmonary resection

Background The development of an advanced robotic platform in 2014 led to increased adoption of minimally invasive (MI) approaches in thoracic surgery. Due to dataset reporting lag, a comprehensive assessment of trends in thoracic approaches has not been analyzed to date. Methods We queried the National Cancer Database (NCDB) for patients with Stage I-III who underwent lung resection from 2010 to 2018. Most published NCDB analyses on lung cancer using pre-2015 data. Overall treatment trends were analyzed, with geographic, institutional, and socioeconomic characteristics evaluated for approach. Results There were 162 335 lung resections, and 131 958 were anatomic. Robotic resection saw a steady increase through 2012 but plateaued in 2013-2014. From 2015 to 2018, another increase correlated with the release of a new platform. Video-assisted thoracoscopic surgery lung resection plateaued in 2014 and decreased in 2018. Open resection steadily decreased. Tumors requiring neoadjuvant radiation had an increase in MI approach with corresponding decreases in the open. On multivariable analysis, African-American race, low volume, Medicaid insurance, and nonacademic setting were associated with a lower likelihood of MI surgery. Conclusions The open approach has decreased since 2010. More than 65% of anatomic resections are now performed in MI. As this trend will continue, it is important that all patients are afforded the opportunity of the least invasive approach.

Automated summary

The development of advanced robotic platforms has led to increased adoption of minimally invasive approaches in thoracic surgery. This study analyzed trends in thoracic approaches using data from the National Cancer Database from 2010 to 2018. The results showed a decrease in open resections and an increase in minimally invasive approaches, particularly robotic resection. Tumors requiring radiation therapy were more likely to be treated with minimally invasive surgery. Factors such as race, hospital volume, insurance, and academic setting were associated with the likelihood of minimally invasive surgery.