Pulmonary open, robotic and thoracoscopic lobectomy (PORTaL) study: Survival analysis of 6,646 cases


Michael S. Kent, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA.
Matthew G. Hartwig, Division of Thoracic Surgery, Duke University, Durham, NC.
Eric Vallières, Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA.
Abbas E. Abbas, Division of Thoracic Surgery, Temple University Health System, Philadelphia, PA.
Robert J. Cerfolio, Division of Thoracic Surgery, NYU Langone, New York, NY.Follow
Mark R. Dylewski, General Thoracic Surgery, Baptist Health Medical Group, South Miami, FL.
Thomas Fabian, Division of Thoracic Surgery, Albany Medical Center, Albany, NY.
Luis J. Herrera, Rod Taylor Thoracic Care Center, Orlando Health UF Health Cancer Center, Orlando FL.
Kimble G. Jett, Division of Thoracic Surgery, Baylor Scott & White The Heart Hospital - Plano, Plano, TX.
Richard S. Lazzaro, Department of Cardiothoracic Surgery, Northwell Health, New York, NY.
Bryan Meyers, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO.
Rishindra M. Reddy, Division of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI.
Michael F. Reed, Division of Thoracic Surgery, Penn State Cancer Institute, Hershey, PA.
David C. Rice, Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer.
Patrick Ross, Main Line Health Care Thoracic Surgery, Main Line Health, Wynewood, PA.
Inderpal S. Sarkaria, Department of Cardiothoracic Surgery, Division of Thoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Lana Y. Schumacher, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA.
Lawrence N. Spier, Department of Cardiothoracic Surgery, Northwell Health, New York, NY.
William B. Tisol, Advocate Aurora HealthFollow
Dennis A. Wigle, Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN.
Michael Zervos, Division of Thoracic Surgery, NYU Langone, New York, NY.


Objective: The aim of this study was to analyze overall survival 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 datasets.

Methods: Retrospective data was collected from 21 institutions from 2013-2019. 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 (IPTW) was used to balance baseline characteristics. Overall survival (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 2,789 RL, 2,661 VATS, and 1,196 OL cases were included. The unadjusted 5-year overall survival rate was highest for OL (84%) followed by RL (81%) and VATS (74%); P=0.008. Similar trends were also observed after IPTW adjustment (RL 81%; VATS 73%, OL 85%, P=0.001). Multivariable Cox regression analyses revealed that OL and RL were associated with significantly higher overall survival compared to VATS (OL vs. VATS: HR 0.64, P

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.



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