Surgical Approaches for Clinical Stage IA Lung Cancer

The study population was derived from the NCD data on patients who underwent surgery for primary lung cancer between January 1, 2014 and December 31, 2015, at 887 surgical units. Records with incomplete data or unspecified patient status within 30 days after surgery were excluded. A total of 78,594 patients who underwent lung cancer resection, with complete data, were registered. Patients with clinical stage IB-IV (N = 30,590) and those who underwent robotic surgery (N = 83) were excluded. Finally, 47,921 patients with surgically treated clinical stage IA lung cancer were selected for analysis.
The NCD registry required the selection of either thoracotomy or VATS as the surgical approach for each lung cancer operation. Herein, we reclassified the surgical approach used in registered cases into thoracotomy or MIA. MIA was divided into complete VATS and VATS with mini-thoracotomy of 8 cm or less (VATS + mini-thoracotomy) [6 (link)] according to the definition of Swanson et al. [7 (link)]. The presence or absence of rib-spreading is not yet specified in the NCD registry.
Accordingly, the comorbidities should be entered in accordance with the established criteria [5 (link)]. The surgical characteristics were analyzed in terms of procedure, type of nodal dissection, blood loss, number of staples applied, maximum wound length, conversion to thoracotomy, and number of access ports [5 (link)]. Postoperative major morbidity was defined in accordance with the Society of Thoracic Surgeons risk model [6 (link), 8 (link), 9 (link)].

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Ikeda N., Endo S., Fukuchi E., Nakajima J., Yokoi K., Chida M., Date H., Iwasaki A., Yokomise H., Sato M., Okumura M., Yamamoto H., Miyata H, & Kondo T. (2020). Current status of surgery for clinical stage IA lung cancer in Japan: analysis of the national clinical database. Surgery Today, 50(12), 1644-1651.

Publication 2020

Blood loss Cancer Dissection Lung cancer Lung operation Patients Robotic surgery Staples Surgeons Surgical Thoracotomy Vats Wound

Corresponding Organization :

Other organizations : Tokyo Medical University, Jichi Medical University, Tokyo Health Care University, The University of Tokyo, Nagoya University, Dokkyo Medical University, Kyoto University, Fukuoka University, Kagawa University, Kagoshima University, Osaka University, Tohoku Medical and Pharmaceutical University Hospital

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Variable analysis

independent variables

Surgical approach (thoracotomy, complete VATS, VATS with mini-thoracotomy)

dependent variables

Postoperative major morbidity
Surgical characteristics (procedure, type of nodal dissection, blood loss, number of staples applied, maximum wound length, conversion to thoracotomy, and number of access ports)

control variables

Patients with surgically treated clinical stage IA lung cancer
Comorbidities (in accordance with established criteria)

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