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Ann Thorac Surg. 2016 Jan;101(1):238-44; discussion 44-5. doi: 10.1016/j.athoracsur.2015.05.136. Epub 2015 Sep 28.

Nodal Upstaging During Lung Cancer Resection Is Associated With Surgical Approach.

Author information

1
Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky. Electronic address: j.martin@uky.edu.
2
Department of Biostatistics, University of Kentucky, Lexington, Kentucky.
3
Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.

Abstract

BACKGROUND:

Recent reports indicate that thoracoscopic lobectomy for lung cancer may be associated with lower rates of surgical upstaging. We queried a statewide cancer registry for differences in upstaging rates and survival by surgical approach.

METHODS:

The Kentucky Cancer Registry (KCR) collects data, including centralized pathology reporting, on cancer patients treated statewide. We performed a retrospective review from 2010 to 2012 to examine clinical and pathologic stage. We assessed rates of upstaging and whether the surgical approach, thoracotomy (THOR) versus minimally invasive techniques (video-assisted thoracic surgery; VATS), had an impact on final pathologic stage and survival.

RESULTS:

The KCR database from 2010 to 2012 contained information on 2830 lung cancer cases, 1964 having THOR procedure and 500 having VATS resections. Preoperatively, 36.4% of THOR were clinically stage 1a versus 47.4% VATS (p = 0.0002). Of these, final pathologic stage remained stage 1a in 30.5% of THOR procedures and 38.0% of VATS (p = 0.0002). The overall nodal upstaging rate for THOR was 9.9% and 4.8% for VATS (p = 0.002). Decreased nodal upstaging was found with VATS, independent of tumor size and extent of resection (odds ratio 0.6, 95% confidence interval [CI]: 0.387 to 0.985, p = 0.04). However, improved survival was found with VATS compared with THOR (hazard ratio 0.733, 95% CI: 0.592 to 0.907, p = 0.0042).

CONCLUSIONS:

Consistent with other reports, we report a lower upstaging rate with VATS. Nevertheless, there is a survival advantage in VATS patients. Although selection bias may play a role in these observed differences, the improved quality of life measures associated with VATS may explain survival improvement despite lower surgical upstaging.

PMID:
26428690
PMCID:
PMC4689653
DOI:
10.1016/j.athoracsur.2015.05.136
[Indexed for MEDLINE]
Free PMC Article

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