USA: Minimally Invasive Pneumonectomy vs Open Pneumonectomy

As thoracic surgery techniques evolve, minimally invasive pneumonectomy (MIP) is increasingly being compared to traditional open pneumonectomy (OP) for patient outcomes and surgical efficiency. Recent studies have highlighted the potential benefits of MIP, while also identifying key factors that contribute to the need for conversion to open procedures.

A recent study involving 3,784 patients with non-small cell lung cancer who underwent pneumonectomy found no significant survival benefit of minimally invasive techniques over traditional open surgery. The researchers showed comparable 30-day and 90-day mortality rates and median overall survival times for all surgical approaches, indicating that minimally invasive pneumonectomy does not provide a survival benefit over the open surgical method.

The findings were published online in The Annals of Thoracic Surgery on August 8, 2024.

Minimally invasive pneumonectomy, performed through small incisions using video-assisted thoracoscopic surgery (VATS) or robotic assistance, offers several advantages over the conventional open approach. These include reduced postoperative pain, shorter recovery times, and fewer complications such as wound infections and prolonged air leaks. Savan K. Shah, Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois, USA, and colleagues aimed to determine if MIP for non-small cell lung cancer (NSCLC) provides a survival advantage over open pneumonectomy.

For this purpose, the researchers queried patients who underwent pneumonectomy for NSCLC between 2015 and 2020 from the National Cancer Database. The surgical approaches were classified into robot-assisted (RATS), video-assisted thoracoscopic (VATS), and open pneumonectomy.

Propensity score matching was employed to ensure balanced patient cohorts. Both univariate and multivariate regression analyses were conducted to explore the relationship between surgical approach and 30- and 90-day mortality, while a Cox proportional hazards model was utilized to evaluate overall survival.

Study Findings

• 3,784 patients were identified, including 73% open, 19% VATS, and 8% RATS.
• The overall conversion rate from minimally invasive to open was 29.5%.
• After propensity matching 212 patients per cohort, there were no differences between open, VATS, and RATS 30-day (9.4% versus 8.5% versus 7.5%, respectively) or 90-day mortality (14.2% versus 12.3% versus 10.4%, respectively).
• Median overall survival was similar among open (48 months), VATS (51.0 months), and RATS approaches (50 months).
• On multivariate analysis of the matched cohort, there was no association between approach and overall survival.
• RATS (OR 0.67) and neoadjuvant chemotherapy (OR 0.52) were protective against conversion to open.

"The findings showed that minimally invasive pneumonectomy can achieve short-term and long-term survival rates comparable to those of open pneumonectomy," the researchers concluded.

Reference

Shah, S. K., Khan, A. A., Basu, S., & Seder, C. W. (2024). Minimally Invasive Pneumonectomy vs Open Pneumonectomy: Outcomes and Predictors of Conversion. The Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2024.07.027