title: Nodal Upstaging During Lung Cancer Resection Is Associated With Surgical Approach.
abstract: BACKGROUND
  Recent reports indicate that thoracoscopic lobectomy for lung cancer may be associated with lower rates of surgical upstaging. We queried a statewide cancer registry for differences in upstaging rates and survival by surgical approach.
  
  
  METHODS
  The Kentucky Cancer Registry (KCR) collects data, including centralized pathology reporting, on cancer patients treated statewide. We performed a retrospective review from 2010 to 2012 to examine clinical and pathologic stage. We assessed rates of upstaging and whether the surgical approach, thoracotomy (THOR) versus minimally invasive techniques (video-assisted thoracic surgery; VATS), had an impact on final pathologic stage and survival.
  
  
  RESULTS
  The KCR database from 2010 to 2012 contained information on 2830 lung cancer cases, 1964 having THOR procedure and 500 having VATS resections. Preoperatively, 36.4% of THOR were clinically stage 1a versus 47.4% VATS (p = 0.0002). Of these, final pathologic stage remained stage 1a in 30.5% of THOR procedures and 38.0% of VATS (p = 0.0002). The overall nodal upstaging rate for THOR was 9.9% and 4.8% for VATS (p = 0.002). Decreased nodal upstaging was found with VATS, independent of tumor size and extent of resection (odds ratio 0.6, 95% confidence interval [CI]: 0.387 to 0.985, p = 0.04). However, improved survival was found with VATS compared with THOR (hazard ratio 0.733, 95% CI: 0.592 to 0.907, p = 0.0042).
  
  
  CONCLUSIONS
  Consistent with other reports, we report a lower upstaging rate with VATS. Nevertheless, there is a survival advantage in VATS patients. Although selection bias may play a role in these observed differences, the improved quality of life measures associated with VATS may explain survival improvement despite lower surgical upstaging.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky. Electronic address: j.martin@uky.edu.
authors.forename: Jeremiah T
authors.initials: JT
authors.lastname: Martin
authors.affiliation: Department of Biostatistics, University of Kentucky, Lexington, Kentucky.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Durbin
authors.affiliation: Department of Biostatistics, University of Kentucky, Lexington, Kentucky.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Biostatistics, University of Kentucky, Lexington, Kentucky.
authors.forename: Tamas
authors.initials: T
authors.lastname: Gal
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Angela
authors.initials: A
authors.lastname: Mahan
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Victor
authors.initials: V
authors.lastname: Ferraris
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zwischenberger
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*