P169. Elective Open Surgery for Lung Cancer is Now Used for a Select Patient Population
Presented During: Thoracic Poster Session II
Memorial Sloan Kettering Cancer Center
New York, NY
United States - Contact Me
Dr. Matthew Skovgard is a senior Thoracic Surgery Fellow at Memorial Sloan Kettering Cancer Center set to graduate in July 2025. He completed residency at NYP-Cornell and two years of translational research fellowship at MSKCC under the guidance of Dr. Prasad Adusumilli. His research interests include thoracic oncology, immunotherapy, and the tumor immune microenvironment.
Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit
Room: Poster Area, Exhibit Hall
Description
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.
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
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.
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