Photo Credit: iStock.com/Mohammed Haneefa Nizamudeen

Open lung resection was linked to higher margin positivity rates than robotic surgery or VATS, with wedge resection and advanced disease also increasing risk.

Rates of margin positivity after lung resection were no different between patients undergoing robotic surgery and video-assisted thoracoscopic surgery (VATS), according to a study published in Clinical Lung Cancer.

“However, open resection had increased rates of margin positivity compared to other modalities,” wrote corresponding author Olugbenga T. Okusanya, MD, and colleagues.

The retrospective cohort study included 226,884 adults with non–small-cell lung cancer in the National Cancer Database who underwent surgical lung resection between 2010 and 2019. Among them, 4.2% had positive margins after surgery.

More than half the patients (117,383) had an open surgical resection, 35,864 patients had robotic resection, and 73,597 had VATS resection. Margin positivity rates were 4.8% with open resection, 3% with robotic resection, and 3.5% with VATS resection, according to the study.

Margin positivity was 6.1% with wedge resection, 3.1% with segmentectomy, and 3.7% with lobectomy. Researchers offered several theories to explain the link between positive margins and wedge resection.

“Patients undergoing wedge resections may not be candidates for a larger resection, thus leading to a positive margin,” they wrote. “Second, there may be limited utilization of intraoperative frozen margin assessments in these patients. Lastly, more so than anatomic resections, there is a lower likelihood of being certain of negative margins preoperatively. Margins during a wedge are completely determined by the surgeon and not anatomical boundaries.”

The study showed poorer overall outcomes among patients with positive margins. Specifically, 30-day mortality was 3.3% in patients with a positive margin compared with 1.5% in patients with a negative margin, and 90-day mortality was 6.9% in patients with a positive margin compared with 2.9% in patients with a negative margin. Readmission rates were 6.9% with a positive margin and 5.2% with a negative margin.

Multivariable analysis identified several factors associated with margin positivity after resection: older age, male sex, open resection, wedge resection, higher clinical stage, larger tumor size, squamous and adenosquamous histologies, and a higher Charlson-Deyo Comorbidity Index.

“Our study provides thoracic surgeons valuable insights on the factors associated with positive margins and the importance of achieving an R0 resection,” researchers wrote, “which could potentially lead to improved margin positivity rates and thus improved outcomes.”