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Improvements in perioperative outcomes for non-small cell lung cancer: a decade-long analysis

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Abstract

Background

Video-assisted thoracic surgery (VATS) procedures for non-small cell lung cancer (NSCLC) have steadily increased and have become the gold standard, but their prognostic advantage compared with thoracotomy has not been elucidated. This study retrospectively evaluated perioperative characteristics of VATS for NSCLC over time.

Methods

We collected the clinical data of 760 patients with NSCLC who underwent pulmonary resection over the past decade, classifying patients into early (2011–2015) and late (2016–2020) periods. Changes in NSCLC patient characteristics, surgical approaches, perioperative factors, postoperative morbidities, and prognoses were analyzed.

Results

Patients in the late period were older (p = 0.01), had more comorbidities (p = 0.01), and had earlier-stage cancer (p < 0.01) than those in the early period. The late period had significantly fewer surgical procedures for lobectomy or extended resection beyond lobectomy (p < 0.01), open thoracotomies (p < 0.01), postoperative (p = 0.02) and severe morbidities (p < 0.01), and a significantly shorter postoperative hospital stay than the early period. Surgical procedures of lobectomy or extended resection beyond lobectomy (p < 0.01) were significant risk factors for postoperative morbidity, and being in the early period (p < 0.01) and surgical procedures of lobectomy or extended resection beyond lobectomy (p < 0.01) were significant risk factors for severe postoperative morbidities. The overall survival prognosis significantly differed between the groups (p = 0.02) but progression-free survival did not (p = 0.89).

Conclusions

The incidence of postoperative morbidities decreased over time in older patients and patients with more comorbidities. The prognosis of patients with NSCLC did not change with increasing VATS or sublobar resection.

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Abbreviations

MIS:

Minimally invasive surgery

VATS:

Video-assisted thoracic surgery

NSCLC:

Non-small cell lung cancer

CEA:

Carcinoembryonic antigen

BI:

Brinkman index

COPD:

Chronic obstructive pulmonary disease

IP:

Interstitial pneumonia

CCI:

Charlson comorbidity index

%VC:

Percent-predicted vital capacity

FEV1%:

Forced expiratory volume in 1s as a percentage of forced vital capacity

H-VATS:

Hybrid VATS

RATS:

Robot-assisted thoracic surgery

OR:

Odds ratio

CI:

Confidence interval

RFS:

Relapse-free survival

OS:

Overall survival

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Acknowledgements

We thank H. Nikki March, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

This study has not been funded.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan

    Nozomu Motono, Takaki Mizoguchi, Masahito Ishikawa, Shun Iwai, Yoshihito Iijima & Hidetaka Uramoto

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  1. Nozomu Motono
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  2. Takaki Mizoguchi
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Correspondence to Nozomu Motono.

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The following authors have no conflicts of interest or financial ties to disclose: Dr. Nozomu Motono, Dr. Takaki Mizoguchi, Dr. Masahito Ishikawa, Dr. Shun Iwai, Dr. Yoshihito Iijima, Dr. Hidetaka Uramoto.

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Motono, N., Mizoguchi, T., Ishikawa, M. et al. Improvements in perioperative outcomes for non-small cell lung cancer: a decade-long analysis. Surg Endosc 37, 172–179 (2023). https://doi.org/10.1007/s00464-022-09471-9

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  • DOI: https://doi.org/10.1007/s00464-022-09471-9

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