Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study: Survival Analysis of 6646 Cases

Objective: The aim of this study was to analyze overall survival (OS) of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS), and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions.

Summary Background Data: Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative data sets.

Methods: Retrospective data was collected from 21 institutions from 2013 to 2019. Consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting was used to balance baseline characteristics. OS was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors.

Results: A total of 2789 RL, 2661 VATS, and 1196 OL cases were included. The unadjusted 5-year OS rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P=0.008. Similar trends were also observed after inverse-probability of treatment weighting adjustment (RL 81%; VATS 73%, OL 85%, P=0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher OS compared with VATS (OL vs. VATS: hazard ratio=0.64, P<0.001 and RL vs. VATS: hazard ratio=0.79; P=0.007).

Conclusions: Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.

This is a pre-copyedited, author-produced version of an article accepted for publication in Annals of Surgery. The published version of record [Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study. Annals of Surgery 277, 6 p1002-1009 (2023)] is available online at: 10.1097/SLA.0000000000005820.

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Work Title Pulmonary Open, Robotic, and Thoracoscopic Lobectomy (PORTaL) Study: Survival Analysis of 6646 Cases
Access
Open Access
Creators
  1. Michael S. Kent
  2. Matthew G. Hartwig
  3. Eric Vallières
  4. Abbas E. Abbas
  5. Robert J. Cerfolio
  6. Mark R. Dylewski
  7. Thomas Fabian
  8. Luis J. Herrera
  9. Kimble G. Jett
  10. Richard S. Lazzaro
  11. Bryan Meyers
  12. Rishindra M. Reddy
  13. Michael F. Reed
  14. David C. Rice
  15. Patrick Ross
  16. Inderpal S. Sarkaria
  17. Lana Y. Schumacher
  18. Lawrence N. Spier
  19. William B. Tisol
  20. Dennis A. Wigle
  21. Michael Zervos
Keyword
  1. Lobectomy
  2. Lung cancer
  3. Robotics
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Annals of Surgery
Publication Date June 1, 2023
Publisher Identifier (DOI)
  1. https://doi.org/10.1097/SLA.0000000000005820
Deposited February 19, 2024

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Version 1
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  • Created
  • Added Pulmonary_Open__Robotic_and_Thoracoscopic.378.pdf
  • Added Creator Michael S. Kent
  • Added Creator Matthew G. Hartwig
  • Added Creator Eric Vallières
  • Added Creator Abbas E. Abbas
  • Added Creator Robert J. Cerfolio
  • Added Creator Mark R. Dylewski
  • Added Creator Thomas Fabian
  • Added Creator Luis J. Herrera
  • Added Creator Kimble G. Jett
  • Added Creator Richard S. Lazzaro
  • Added Creator Bryan Meyers
  • Added Creator Rishindra M. Reddy
  • Added Creator Michael F. Reed
  • Added Creator David C. Rice
  • Added Creator Patrick Ross
  • Added Creator Inderpal S. Sarkaria
  • Added Creator Lana Y. Schumacher
  • Added Creator Lawrence N. Spier
  • Added Creator William B. Tisol
  • Added Creator Dennis A. Wigle
  • Added Creator Michael Zervos
  • Published
  • Updated Keyword, Description Show Changes
    Keyword
    • Lobectomy, Lung cancer, Robotics
    Description
    • <p>Objective: The aim of this study was to analyze overall survival (OS) of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS), and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions. Summary Background Data: Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative data sets. Methods: Retrospective data was collected from 21 institutions from 2013 to 2019. Consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting was used to balance baseline characteristics. OS was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors. Results: A total of 2789 RL, 2661 VATS, and 1196 OL cases were included. The unadjusted 5-year OS rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P=0.008. Similar trends were also observed after inverse-probability of treatment weighting adjustment (RL 81%; VATS 73%, OL 85%, P=0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher OS compared with VATS (OL vs. VATS: hazard ratio=0.64, P&lt;0.001 and RL vs. VATS: hazard ratio=0.79; P=0.007). Conclusions: Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.</p>
    • <p>Objective: The aim of this study was to analyze overall survival (OS) of robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VATS), and open lobectomy (OL) performed by experienced thoracic surgeons across multiple institutions.
    • Summary Background Data: Surgeons have increasingly adopted RL for resection of early-stage lung cancer. Comparative survival data following these approaches is largely from single-institution case series or administrative data sets.
    • Methods: Retrospective data was collected from 21 institutions from 2013 to 2019. Consecutive cases performed for clinical stage IA-IIIA lung cancer were included. Induction therapy patients were excluded. The propensity-score method of inverse-probability of treatment weighting was used to balance baseline characteristics. OS was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to evaluate association among OS and relevant risk factors.
    • Results: A total of 2789 RL, 2661 VATS, and 1196 OL cases were included. The unadjusted 5-year OS rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P=0.008. Similar trends were also observed after inverse-probability of treatment weighting adjustment (RL 81%; VATS 73%, OL 85%, P=0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher OS compared with VATS (OL vs. VATS: hazard ratio=0.64, P&lt;0.001 and RL vs. VATS: hazard ratio=0.79; P=0.007).
    • Conclusions: Our finding from this large multicenter study suggests that patients undergoing RL and OL have statistically similar OS, while the VATS group was associated with shorter OS. Further studies with longer follow-up are necessary to help evaluate these observations.</p>
  • Updated