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 to 2020. We stratified patients into those undergoing a minimally invasive resection (video-assisted thoracoscopic surgery [VATS]/robotic) or open, while accounting for conversions. We also compared VATS with 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 2837 patients, 756 procedures (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 years vs 66.0 ± 9.9 years), sex, race, tumor histology, and location (all Conclusions: 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.