Video-Assisted Thoracoscopic Lobectomy for Lung Cancer: Current Practice Patterns and Predictors of Adoption

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• Video-assisted thoracoscopic surgery (VATS) lobectomy is a safe, minimally invasive approach for lung cancer.
• Despite proven efficacy, VATS lobectomy is underutilized, with less than half of procedures performed using this method.
• Understanding predictors of VATS adoption is crucial for improving surgical practice patterns.

Purpose of the Study:

• To examine national lobectomy practice patterns.
• To identify specific predictors for the adoption of VATS lobectomy.
• To analyze trends in VATS lobectomy utilization from 2010 to 2014.

Main Methods:

• Analysis of nationwide hospital data (2010-2014) for open and VATS lobectomy procedures in primary lung cancer.
• Utilized propensity score matching (1:1) to compare VATS and open operations based on clinical characteristics.
• Employed logistic regression to identify independent predictors of VATS utilization and assessed secondary outcomes like complications and mortality.

Main Results:

• Over 17,000 lobectomies were identified; VATS utilization increased from 39.6% to 43.8% between 2010 and 2014.
• VATS adoption was significantly higher for thoracic surgeons, high-volume surgeons (≥15 lobectomies/year), and surgeons in the Northeast region.
• Independent predictors of VATS utilization included surgeon volume, specialty training, hospital characteristics, and geographic region.

Conclusions:

• National VATS lobectomy rates are rising, particularly among specialized and high-volume surgeons.
• Surgeon volume and specialty are significant independent predictors of VATS lobectomy.
• Centralizing care may enhance VATS lobectomy rates and mitigate regional practice variations.