National Trends, Safety and Effectiveness of Minimally Invasive Concomitant Chest Wall Resection for Locally Advanced Lung Cancer

Objective Concomitant chest wall resection for locally advanced lung cancer is traditionally performed via an open approach. The safety and effectiveness of minimally invasive approaches for chest wall resections are unknown. Methods We used the National Cancer Database to identify patients undergoing lobectomy/bi-lobectomy with concomitant chest wall resection from 2010-2020. We stratified patients into those undergoing a minimally invasive resection(VATS/robotic) or open, while accounting for conversions. We also compared VATS to robotic approaches. The main outcomes were length of stay, mortality, readmissions, and overall survival. We used multivariable, Kaplan-Meier and Cox-proportional models to identify associations. Results Of 2,837 patients, 756(26.6%) were started minimally invasive, of which 23.1% were robotic. There were 237(31.3%) conversions. Patients undergoing a minimally invasive operation were similar in terms of age (65.2±9.8 vs 66.0±9.9), sex, race, tumor histology, and location (all p>0.05), but had smaller cancers (5.4±2.6cm vs 6.2±4.3cm; p<0.001) compared to open. They also had shorter length of stay (8.6±7.6 days vs 9.7±9.3 days; p<0.001), but similar unadjusted 90-day mortality (8.2% vs 8.0%; p=0.999). Neoadjuvant therapy was associated with less minimally invasive approaches (aOR = 0.69; p=<0.001). Larger cancers were associated with less minimally invasive operations, and higher conversions. However, the robotic approach was associated with lower conversion rates than VATS across all tumor sizes. Overall survival was equivalent (Figure 1). Conclusion The use of minimally invasive approaches to concomitant chest wall resection is increasing. Although conversions to open are common, this approach is safe, and is associated with shorter hospital stays. Overall survival is equivalent to the open approach.