Minimally invasive lobectomy is associated with lower noncancer-specific mortality in elderly patients: A propensity score matched competing risks analysis Journal Article


Authors: Hristov, B.; Eguchi, T.; Bains, S.; Dycoco, J.; Tan, K. S.; Isbell, J. M.; Park, B. J.; Jones, D. R.; Adusumilli, P. S.
Article Title: Minimally invasive lobectomy is associated with lower noncancer-specific mortality in elderly patients: A propensity score matched competing risks analysis
Abstract: Objective: To investigate cancer- and noncancer-specific mortality following lobectomy by minimally invasive surgery (MIS) versus open thoracotomy in elderly patients with nonsmall cell lung cancer (NSCLC). Background: Two-thirds of patients with NSCLC are >= 65 years of age. As age increases, the risk of competing events, such as noncancer death, also increases. Methods: Elderly patients (>= 65 yrs of age) who have undergone curative-intent lobectomy for stage I-III NSCLC without induction therapy (2002-2013) were included (n=1,303). Of those, 607 patients had undergone MIS and 696 had undergone thoracotomy. Propensity-score matching was performed to identify pairs of thoracotomy and MIS patients with comparable clinical characteristics (eg, year of surgery, comorbidities, and pulmonary function). Association between surgical approach (MIS vs thoracotomy) and lung cancer-specific and noncancer-specific cumulative incidence of death (CID) was analyzed using competing risks approach. Results: Following propensity score matching of patients who had undergone thoracotomy (n=338) versus MIS (n=338), MIS was associated with shorter length of stay (P <0.001), lower noncancer-specific 1-year mortality (P=0.027), and lower noncancer-specific CID (P=0.014) compared with thoracotomy; there was no difference in lung cancer-specific CID between surgical approaches. On multivariable analysis, thoracotomy was a significant risk factor for noncancer-specific death (subhazard ratio 2.45, 95% CI 1.18-5.06, P=0.016) independent of age, sex, and diffusion capacity of the lungs for carbon monoxide. Conclusion: In a propensity score-matched cohort, multivariable analysis has indicated that lobectomy performed by MIS is associated with lower incidence of noncancer-specific mortality compared with lobectomy performed by open thoracotomy in elderly patients with NSCLC.
Keywords: thoracotomy; minimally invasive surgery; lobectomy; elderly; outcomes; vats; cell lung-cancer; term; assisted thoracic-surgery; video-assisted thoracic surgery; society; competing risk; thoracoscopic lobectomy; equivalent; robotic-assisted thoracic surgery; lower morbidity
Journal Title: Annals of Surgery
Volume: 270
Issue: 6
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2019-01-01
Start Page: 1161
End Page: 1169
Language: English
ACCESSION: WOS:000503422400118
DOI: 10.1097/sla.0000000000002772
PROVIDER: wos
PUBMED: 29672399
Notes: Source: Wos
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MSK Authors
  1. Bernard J Park
    175 Park
  2. Joseph Dycoco
    25 Dycoco
  3. Sarina Bains
    19 Bains
  4. David Randolph Jones
    210 Jones
  5. Takashi   Eguchi
    71 Eguchi
  6. Kay See   Tan
    117 Tan
  7. James Michael Isbell
    52 Isbell