Elective Open Surgery for Lung Cancer is Now Used for a Select Patient Population
Presented During:
Sunday, May 4, 2025: 9:00AM - 4:00PM
Seattle Convention Center | Summit
Posted Room Name:
Poster Area, Exhibit Hall
Abstract No:
P0169
Submission Type:
Abstract Submission
Authors:
Matthew Skovgard (1), Kay See Tan (1), Benjamin Resio (1), Stijn Vanstraelen (1), Prasad Adusumilli (1), Manjit Bains (1), Matthew Bott (1), Robert Downey (1), Katherine Gray (1), James Huang (1), James Isbell (1), Daniela Molena (1), Bernard Park (1), Valerie Rusch (1), Smita Sihag (1), David Jones (1), Gaetano Rocco (1)
Institutions:
(1) Memorial Sloan Kettering Cancer Center, New York, NY
Submitting Author:
Matthew Skovgard
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
Co-Author(s):
Kay See Tan
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
Benjamin Resio
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
Stijn Vanstraelen
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*Prasad Adusumilli
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*Manjit Bains
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*Matthew Bott
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
Robert Downey
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
Katherine Gray
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*James Huang
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*James Isbell
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*Daniela Molena
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*Bernard Park
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*Valerie Rusch
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*Smita Sihag
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*David Jones
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
*Gaetano Rocco
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
Presenting Author:
Matthew Skovgard
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Memorial Sloan Kettering Cancer Center
Memorial Sloan Kettering Cancer Center
Abstract:
Objective: Randomized trials underscore the safety of minimally invasive surgery (MIS) and indicate a growing preference for MIS over open procedures. This study investigates the utilization of elective open thoracotomy for managing lung cancer at a high-volume cancer-designated institution. It aims to identify scenarios where an elective open approach remains pertinent.
Methods: Patients with NSCLC who underwent resection between 2018 and 2024 (n = 3191) via MIS (n = 2676) were compared to those who underwent elective open surgery (n = 515). Preoperative characteristics were compared using Chi-square, Fisher's exact, and Kruskal-Wallis tests. A nomogram was constructed from a multivariable logistic regression model for the outcome of elective open surgery vs MIS. The model included factors defined a-priori to be clinically relevant, as well as factors with p<0.05 in univariable analyses.
Results: Univariate analysis identified factors influencing the choice of elective open surgery vs MIS, including age, sex, smoking history, cardiac comorbidity, FEV1, DLCO, prior same-sided lung surgery, tumor size on CT, tumor SUV, clinical stage, induction therapy, type of resection, and histologic subtype. Multivariable analysis revealed significant associations with age (OR 0.98, 95% CI: [0.97, 1.0]), male sex (OR 1.28 [1.0, 1.63]), prior same-sided lung surgery (OR 2.13 [1.18, 3.72]), primary tumor SUV (OR 1.03 [1.02, 1.05]), clinical stage: stage IB (OR 2.1 [1.4, 3.1]), IIA (OR 4.1 [2.4, 7.0]), IIB (OR 2.8 [1.8, 4.1]), IIIA: T1-2bN2 (OR 3.6 [2.3, 5.6]), IIIA: T4N0 (OR 7.4 [3.7, 15]), IIIA: T3-4N1 (OR 9.2 [3.9, 22.6]), locoregional recurrence (OR 4.1 [2.0, 8.5]), receipt of induction chemotherapy (OR 1.9 [1.2, 3.0]), adenosquamous histology (OR 2.5 [1.1, 2.1]), planned bilobectomy (OR 3.2 [1.5, 7.2]), and planned pneumonectomy (OR 13.2 [3.1, 95.3]). A nomogram based on these factors was constructed (Figure 1).
Conclusions: Elective open surgery continues to play a critical role in managing a specific subset of NSCLC patients, particularly those with larger, more aggressive tumors, advanced clinical stages, and a history of induction therapy. It is imperative to integrate open surgery where indicated into thoracic surgical training programs. Ensuring adequate exposure to open procedures will equip the next generation of thoracic surgeons with the skills necessary to offer optimal surgical care to diverse NSCLC patient profiles.
Methods: Patients with NSCLC who underwent resection between 2018 and 2024 (n = 3191) via MIS (n = 2676) were compared to those who underwent elective open surgery (n = 515). Preoperative characteristics were compared using Chi-square, Fisher's exact, and Kruskal-Wallis tests. A nomogram was constructed from a multivariable logistic regression model for the outcome of elective open surgery vs MIS. The model included factors defined a-priori to be clinically relevant, as well as factors with p<0.05 in univariable analyses.
Results: Univariate analysis identified factors influencing the choice of elective open surgery vs MIS, including age, sex, smoking history, cardiac comorbidity, FEV1, DLCO, prior same-sided lung surgery, tumor size on CT, tumor SUV, clinical stage, induction therapy, type of resection, and histologic subtype. Multivariable analysis revealed significant associations with age (OR 0.98, 95% CI: [0.97, 1.0]), male sex (OR 1.28 [1.0, 1.63]), prior same-sided lung surgery (OR 2.13 [1.18, 3.72]), primary tumor SUV (OR 1.03 [1.02, 1.05]), clinical stage: stage IB (OR 2.1 [1.4, 3.1]), IIA (OR 4.1 [2.4, 7.0]), IIB (OR 2.8 [1.8, 4.1]), IIIA: T1-2bN2 (OR 3.6 [2.3, 5.6]), IIIA: T4N0 (OR 7.4 [3.7, 15]), IIIA: T3-4N1 (OR 9.2 [3.9, 22.6]), locoregional recurrence (OR 4.1 [2.0, 8.5]), receipt of induction chemotherapy (OR 1.9 [1.2, 3.0]), adenosquamous histology (OR 2.5 [1.1, 2.1]), planned bilobectomy (OR 3.2 [1.5, 7.2]), and planned pneumonectomy (OR 13.2 [3.1, 95.3]). A nomogram based on these factors was constructed (Figure 1).
Conclusions: Elective open surgery continues to play a critical role in managing a specific subset of NSCLC patients, particularly those with larger, more aggressive tumors, advanced clinical stages, and a history of induction therapy. It is imperative to integrate open surgery where indicated into thoracic surgical training programs. Ensuring adequate exposure to open procedures will equip the next generation of thoracic surgeons with the skills necessary to offer optimal surgical care to diverse NSCLC patient profiles.
THORACIC:
Lung Cancer
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