Outcomes of elderly stage I lung cancer patients treated with segmentectomy via video assisted thoracoscopic surgery or open resection.

Abstract

7543 Background: Video-assisted thoracic surgery (VATS) is considered an alternative to open lobectomy for the treatment of non-small cell lung cancer (NSCLC). Limited data is available however, regarding the equivalence of open vs. VATS segmental resections, particularly among elderly patients. In this study, we used population-based data to compare postoperative and oncologic outcomes following open vs. VATS segmentectomy for early NSCLC. Methods: We identified all stage I NSCLC patients >65 year treated with VATS or open segmentectomy from the Surveillance, Epidemiology, and End Results registry linked to Medicare claims. We used propensity score methods to control for differences in the baseline characteristics of patients. Overall and lung cancer-specific survival of patients treated with VATS vs. open segmentectomy was compared after adjusting, stratifying, or matching patients based on their propensity score. We performed secondary analyses evaluating perioperative complications, need for intensive care unit (ICU) admission, extended length of stay, and perioperative mortality. These were repeated adjusting for physician characteristics (sociodemographics, specialty, and procedure volume). Results: Of the 577 study patients, 27% underwent VATS resection. VATS were mostly performed by high volume surgeons (p<0.001). Overall (hazard ratio [HR]: 0.80, 95% CI: 0.60-1.06) and lung cancer-specific (HR: 0.71, 95% CI: 0.45-1.12) survival was similar among treatment groups. VATS-treated patients had lower rates of postoperative complications (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.37-0.83), need for ICU admission (OR: 0.18, 95% CI: 0.12-0.28), and decreased length of stay (OR: 0.41, 95% CI: 0.41-0.81) after adjusting for propensity scores. The distribution of all postoperative complications, ICU admission, extended length of stay, and perioperative mortality was not significantly different across groups after adjusting for surgeon characteristics. Conclusions: VATS segmentectomy can be safely performed among elderly patients with early stage NSCLC and is associated with equivalent postoperative and long-term oncologic outcomes.