Phillips Joseph D, Bostock Ian C, Hasson Rian M, Goodney Philip P, Goodman David C, Millington Timothy M, Finley David J
Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
J Thorac Dis. 2019 Mar;11(Suppl 4):S500-S508. doi: 10.21037/jtd.2019.01.05.
Video-assisted thoracoscopic surgery (VATS) has been established as a safe and effective alternative to an open approach for the treatment of early-stage lung cancer. Despite this, differences in utilization across the nation are present. The aims of this study were to: (I) characterize trends in the use of open surgery and VATS for the management of lung cancer across the United States, and (II) describe if particular regions of the country utilize minimally invasive surgery more frequently.
We studied all Medicare beneficiaries from the ages of 65 to 99 years with full Part A and B coverage and no HMO coverage for the years of 2006 and 2014 (the most recent year available at the time of this analysis). Beneficiaries with a diagnosis of lung cancer (ICD-9 codes: 162.0 162.2 162.3 162.4 162.5 162.8 162.9) were selected. Rates of thoracoscopic surgery (CPT codes: 32663, 32666, 32667, 32668, 32669, 32670, 32671) and open lung resections (32505, 32506, 32507, 32608, 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488) were calculated by year and region. Rates in 2006 and 2014 with descriptive statistics and a univariate analysis were performed using Student's -test and chi-square, as appropriate. A two-sided P value <0.05 was considered statistically significant.
A total of 24,368,333 and 23,921,059 beneficiaries for the years of 2006 and 2014 were analyzed. A diagnosis of lung cancer was detected in claims of 167,418 patients (0.7%) in 2006 and 167,506 patients in 2014 (0.7%), which was not significantly different (P=0.7). Among these lung cancer patients, a surgical intervention was performed in 17,249 patients (10.3%) during 2006 and 18,603 patients (11.1%) in 2014 (P=0.01). Among those undergoing surgery, a VATS approach was performed in 2,512 patients (15%) during 2006 and 9,578 patients (54%) during 2014 (P=0.001). In 2006, California, New York, and New Jersey performed the most VATS procedures, in comparison to 2014, when New York, Florida, and California performed the highest number of VATS procedures.
While the prevalence of lung cancer in the United States was unchanged between 2006 and 2014, the use of VATS techniques increased five-fold. Further studies to better understand the adoption or availability of new surgical techniques in lung cancer populations across geographic regions and patient populations are necessary.
电视辅助胸腔镜手术（VATS）已被确立为治疗早期肺癌的一种安全有效的开放性手术替代方法。尽管如此，全国范围内的使用情况仍存在差异。本研究的目的是：（I）描述美国各地肺癌治疗中开放性手术和VATS的使用趋势，以及（II）描述该国特定地区是否更频繁地使用微创手术。
我们研究了2006年和2014年（本分析时可获得的最新年份）年龄在65至99岁之间、享有A部分和B部分全额保险且无健康维护组织（HMO）保险的所有医疗保险受益人。选择诊断为肺癌（ICD - 9编码：162.0、162.2、162.3、162.4、162.5、162.8、162.9）的受益人。按年份和地区计算胸腔镜手术（CPT编码：32663、32666、32667、32668、32669、32670、32671）和开放性肺切除术（32505、32506、32507、32608、32440、32442、32445、32480、32482、32484、32486、32488）的发生率。2006年和2014年的发生率采用学生t检验和卡方检验进行描述性统计和单因素分析，视情况而定。双侧P值<0.05被认为具有统计学意义。
2006年和2014年分别分析了24368333名和23921059名受益人。2006年在167418名患者（0.7%）的理赔申请中检测到肺癌诊断，2014年在167506名患者（0.7%）中检测到，差异无统计学意义（P = 0.7）。在这些肺癌患者中，2006年有17249名患者（10.3%）接受了手术干预，2014年有18603名患者（11.1%）接受了手术干预（P = 0.01）。在接受手术的患者中，2006年有2512名患者（15%）采用了VATS方法，2014年有9578名患者（54%）采用了该方法（P = 0.001）。2006年，加利福尼亚州、纽约州和新泽西州进行的VATS手术最多，而2014年，纽约州、佛罗里达州和加利福尼亚州进行的VATS手术数量最多。
虽然2006年至201年美国肺癌患病率未变，但VATS技术的使用增加了五倍。有必要进行进一步研究，以更好地了解不同地理区域和患者群体中肺癌人群采用新手术技术的情况或可及性。
