DOI: 10.1093/ejcts/ezae009 ISSN: 1873-734X

“Minimally invasive surgery for clinical T4 Non-Small cell lung cancer: National trends and outcomes”

Jorge Humberto Rodriguez-Quintero, Mostafa M Elbahrawy, Anne Michelle Montal, Rajika Jindani, Marc Vimolratana, Mohamed K Kamel, Brendon M Stiles, Neel P Chudgar
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • General Medicine
  • Surgery



Recent randomized data support the perioperative benefits of minimally invasive surgery for non-small cell lung cancer. Its utility for cT4 tumors remains understudied. We, therefore, sought to analyze national trends and outcomes of minimally invasive resections for cT4 cancers.

Materials and Methods

Using the 2010–2019 National Cancer Database, we identified patients with cT4N0-1 non-small cell lung cancer. Patients were stratified by surgical approach. Multivariable logistic analysis was used to identify factors associated with use of a minimally invasive approach. Groups were matched using propensity-score analysis to evaluate perioperative and survival end-points.


The study identified 3,715 patients, among whom 64.1% (n = 2,381) underwent open resection and 35.9% (n = 1,334) minimally invasive resection [robotic-assisted in 31.5% (n = 420); and video-assisted in 68.5% (n = 914)]. Increased minimally invasive surgery use was noted among patients with higher income (≥$40,227, OR 1.24; CI 1.01–1.51) and those treated at academic hospitals (OR 1.25; CI 1.07–1.45). Clinically node-positive patients (OR 0.68; CI 0.55–0.83) and those who underwent neoadjuvant therapy (OR 0.78; CI 0.65–0.93) were less likely to have minimally invasive resection. In matched groups, patients undergoing minimally invasive surgery had a shorter median length of stay (5 vs 6 days, p < 0.001) and no significant differences between 30-day readmissions or 30/90-day mortality. Minimally invasive surgery did not compromise overall survival (log-rank p = 0.487).


Nationally, the use of minimally invasive approaches for patients with cT4N0-1M0 NSCLC has increased substantially. In these patients, minimally invasive surgery is safe and does not compromise perioperative outcomes or survival.

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