Housman Brian, Taioli Emanuela, Gulati Shubham, Flores Raja
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.
Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Transl Cancer Res. 2025 May 30;14(5):2916-2925. doi: 10.21037/tcr-24-1287. Epub 2025 May 13.
Video- and robotic-assisted thoracic surgery are proven safe alternatives to open thoracotomy. But smaller-scale studies examining outcomes between minimally invasive surgery (MIS) and open techniques may fail to capture patterns in health, gender, and race on a national scale. The aim of this study was to identify large-scale trends in the outcomes of MIS in a national database.
We evaluated adverse events following MIS and open lung resection in the Surveillance, Epidemiology, and End Results (SEER) Medicare database from 1992-2015.
A total of 746,441 patients were diagnosed with lung cancer. MIS patients undergoing limited resection (n=5,185) were more likely to be older (74.7 74.0 years), female (59.4% 52.3%), have adenocarcinoma (62.9% 54.6%), live in an urban area (92.1% 86.2%), and have lower comorbidity scores (10.0 11.8). MIS patients undergoing lobectomy (n=4,119) were more likely to be older (73.8 73.1 years), female (57.3% 51.1%), diagnosed at stage I/II (79.8% 75.9%), have adenocarcinoma (63.7% 54.8%), live in an urban area (92.2% 85.2%), and have lower comorbidity scores (8.8 10.4). Black patients were less likely to receive MIS (4.5% 5.9%).
There are multiple differences between MIS and open surgery, but it is unclear if any confer a clinical benefit. Patients undergoing MIS tend to be healthier with earlier-stage disease, suggesting biases in patient selection. The data suggests that lung cancer should be considered a women's health issue and raises the concern that Black Americans do not have equal access to screening and treatment. While these results support the continued use of MIS, they should not substitute good surgical judgment when open surgery is required.
电视辅助胸腔镜手术和机器人辅助胸腔镜手术已被证明是开胸手术的安全替代方案。但规模较小的研究在比较微创手术（MIS）和开放手术的结果时，可能无法在全国范围内捕捉到健康、性别和种族方面的模式。本研究的目的是在一个全国性数据库中确定MIS结果的大规模趋势。
我们在1992 - 2015年的监测、流行病学和最终结果（SEER）医疗保险数据库中评估了MIS和开放性肺切除术后的不良事件。
共有746,441名患者被诊断为肺癌。接受有限切除的MIS患者（n = 5,185）更可能年龄较大（74.7对74.0岁）、为女性（59.4%对52.3%）、患有腺癌（62.9%对54.6%）、居住在城市地区（92.1%对86.2%）且合并症评分较低（10.0对11.8）。接受肺叶切除的MIS患者（n = 4,119）更可能年龄较大（73.8对73.1岁）、为女性（57.3%对51.1%）、诊断为I/II期（79.8%对75.9%）、患有腺癌（63.7%对54.8%）、居住在城市地区（92.2%对85.2%）且合并症评分较低（8.8对10.4）。黑人患者接受MIS的可能性较小（4.5%对5.9%）。
MIS和开放手术之间存在多种差异，但尚不清楚是否有任何差异能带来临床益处。接受MIS的患者往往病情较轻且健康状况较好，这表明在患者选择上存在偏差。数据表明肺癌应被视为一个女性健康问题，并引发了对美国黑人无法平等获得筛查和治疗的担忧。虽然这些结果支持继续使用MIS，但在需要进行开放手术时，它们不应取代良好的手术判断。
