Journal of surgical oncology · 2025
Safety of Minimally Invasive Sublobar Pulmonary Metastasectomy in the Frail Patient.
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Sidhu Hannah, Ding Li, Rosenberg Graeme M, Harano Takashi, Wightman Sean C, Atay Scott M, Kim Anthony W, Udelsman Brooks V
Аннотация
BACKGROUND AND OBJECTIVES: Minimally invasive (MI) pulmonary metastasectomy may improve access in frail patients who are at high-risk for complications after thoracotomy. We compared postoperative complications among frail and non-frail patients undergoing pulmonary metastasectomy.
METHODS: The Nationwide Readmissions Database (2017-2019) identified adult patients who underwent pulmonary metastasectomy. Frailty was determined using Johns Hopkins Adjusted Clinical Groups indicator. Independent propensity-score matches were performed for the open and MI cohorts. Odds ratio (OR) and incidence rate (IRR) were used to compare morbidity and length of stay (LOS).
RESULTS: A total of 8778 patients underwent pulmonary metastasectomy, of which 3.1% (270/8778) were frail. In the open cohort after propensity-score matching (98-matched pairs), frail patients had more complications (OR 2.1; p < 0.0001) and increased LOS (IRR 2.6; p < 0.0001), both of which did not improve with a sublobar resection. In the MI cohort (167-matched pairs), frailty was associated with increased morbidity (OR 2.6; p < 0.001) and increased LOS (IRR 2.8; p < 0.001), but both were mitigated by sublobar resection (morbidity OR 0.44; p = 0.005; LOS IRR 0.66; p < 0.001).
CONCLUSIONS: A MI sublobar resection significantly mitigates the risk of pulmonary metastasectomy in frail patients. Thoracotomy and lobectomy should be approached cautiously in this population.
METHODS: The Nationwide Readmissions Database (2017-2019) identified adult patients who underwent pulmonary metastasectomy. Frailty was determined using Johns Hopkins Adjusted Clinical Groups indicator. Independent propensity-score matches were performed for the open and MI cohorts. Odds ratio (OR) and incidence rate (IRR) were used to compare morbidity and length of stay (LOS).
RESULTS: A total of 8778 patients underwent pulmonary metastasectomy, of which 3.1% (270/8778) were frail. In the open cohort after propensity-score matching (98-matched pairs), frail patients had more complications (OR 2.1; p < 0.0001) and increased LOS (IRR 2.6; p < 0.0001), both of which did not improve with a sublobar resection. In the MI cohort (167-matched pairs), frailty was associated with increased morbidity (OR 2.6; p < 0.001) and increased LOS (IRR 2.8; p < 0.001), but both were mitigated by sublobar resection (morbidity OR 0.44; p = 0.005; LOS IRR 0.66; p < 0.001).
CONCLUSIONS: A MI sublobar resection significantly mitigates the risk of pulmonary metastasectomy in frail patients. Thoracotomy and lobectomy should be approached cautiously in this population.