Introduction: Minimally invasive approaches are increasingly being used for the conduct of complex surgical procedures. Whether the benefits of minimally invasive approaches compared to thoracotomy for sublobar and lobar lung resection for NSCLC are realized for patients undergoing pneumonectomy is not clear. Methods: The National Cancer Database was queried for patients who underwent pneumonectomy for NSCLC from 2010 to 2014. Case data from patients who underwent resection by minimally invasive surgery (MIS) were compared with those from patients who received thoracotomy (open) in an intention‐to‐treat analysis. Associations between potential covariates and treatment were analyzed using the Pearson chi‐square test for categorical variables and Wilcoxon rank sum test for continuous variables. Univariable and multivariable logistic models and proportional hazards model were used to assess the effect of surgical approach on 30‐day and 90‐day mortality and overall survival. Relative prognosis was summarized using odds ratios and hazards ratios estimates and 95% confidence limits. Results: A total of 4,938 patients underwent pneumonectomy during the study period, of which 755 (15.3%) were completed by MIS. No difference was noted in 30‐ and 90‐day mortality rates for MIS compared to open approaches (6.8% and 12.3% versus 6.7% and 11.9%, respectively; p = 0.9 and 0.86, respectively). Tumor histology and stage characteristics were similar between the two groups. The mean number of lymph nodes examined was higher in the MIS group compared to the open thoracotomy group (17.1 ± 0.4 versus 16.1 ± 0.2, p = 0.034). The conversion rate for the MIS cohort was 36.7%. Surgical approach was not associated with any difference in perioperative mortality with univariable or multivariable analysis. MIS was associated with improved overall survival on univariable analysis, but this was not evident with multivariable analysis. Conclusions: Pneumonectomy performed by minimally invasive approaches does not compromise perioperative mortality or long‐term outcomes. Further investigation into the impact of minimally invasive approaches on perioperative outcomes for whole‐lung resection is warranted.

中文翻译：

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微创方法不会影响全肺切除术的结果，利用国家癌症数据库的比较

简介：微创方法越来越多地用于进行复杂的外科手术。对于接受全肺切除术的患者，与开胸手术相比，微创方法对 NSCLC 亚肺叶切除术和肺叶切除术的益处是否实现尚不清楚。方法：查询国家癌症数据库中 2010 年至 2014 年因 NSCLC 接受全肺切除术的患者。将接受微创手术 (MIS) 切除术的患者的病例数据与有意接受开胸手术的患者的病例数据进行比较。治疗分析。使用分类变量的 Pearson 卡方检验和连续变量的 Wilcoxon 秩和检验分析潜在协变量和治疗之间的关联。使用单变量和多变量逻辑模型和比例风险模型评估手术方法对 30 天和 90 天死亡率和总生存率的影响。使用优势比和风险比估计值以及 95% 置信限来总结相对预后。结果：研究期间共有 4,938 名患者接受了全肺切除术，其中 755 名 (15.3%) 由 MIS 完成。与开放式手术相比，MIS 的 30 天和 90 天死亡率没有差异（分别为 6.8% 和 12.3% 对 6.7% 和 11.9%；分别为 p = 0.9 和 0.86）。两组的肿瘤组织学和分期特征相似。与开胸手术组相比，MIS 组检查的淋巴结平均数量更高（17.1 ± 0.4 对 16.1 ± 0.2，p = 0.034）。MIS 队列的转化率为 36.7%。通过单变量或多变量分析，手术方法与围手术期死亡率的任何差异无关。在单变量分析中，MIS 与总生存期的改善相关，但在多变量分析中并不明显。结论：通过微创方法进行的肺切除术不会影响围手术期死亡率或长期结果。有必要进一步研究微创方法对全肺切除术围手术期结果的影响。结论：通过微创方法进行的肺切除术不会影响围手术期死亡率或长期结果。有必要进一步研究微创方法对全肺切除术围手术期结果的影响。结论：通过微创方法进行的肺切除术不会影响围手术期死亡率或长期结果。有必要进一步研究微创方法对全肺切除术围手术期结果的影响。