Outcomes of minimally invasive lung resection with concomitant chest wall resection in non-small cell lung cancer (NSCLC).

Background: Traditionally, lung and chest wall (CW) resections were performed via an open approach for non-small cell lung cancer (NSCLC) with CW involvement. Our objective is to examine the outcomes of patients with NSCLC and CW involvement resected through a minimally invasive (MIS) [video-assisted thoracoscopic surgery (VATS) or robotic] approach. Methods: This is a retrospective cohort study of the 2021 National Cancer Database (NCDB). We examined patients >18 years who underwent MIS or open lung and CW resection for clinically N0M0 NSCLC between 2010 and 2020. Outcomes studied include 30-, 90-day mortality, and readmission. Additionally, the number of nodes examined, margins, and rate of nodal upstaging were analyzed. Results: A total of 1,370 patients treated with an open resection and 352 patients treated with a MIS approach were examined. The average age at diagnosis was 66 years. The average primary tumor size was 4.75 cm (3.2-6.5 cm) in the MIS cohort and 5.7 cm (4.2-7.3 cm) in the open cohort. There was a significant difference in 30-day mortality between cohorts (P=0.002). There were no significant differences in other outcome measures (90-day mortality, readmission). There was no significant difference in margin positivity or nodal upstaging. There were more overall nodes examined in the MIS cohort (14 Conclusions: This study suggests that MIS lung and CW resection is associated with similar short and long-term outcomes in most measures as compared to open surgery.