Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study

SIMPLE SUMMARY: The minimally invasive approach (MIA) for lung cancer has gained popularity in recent years thanks to their efficacy and safety. In France, we have no information on the diffusion of MIAs across different hospitals and regions. Our work consisted of evaluating the diffusion of this approach and its variability within each region and from one region to another. Our study showed that the rate of MIAs increased significantly from 2013 to 2020. We also found that the hospital volume, hospital type, and period were significantly related to the adjusted rate of MIAs. The variability between regions was high since 18% of the variance was due to systematic differences between regions. The MIA is now a standard surgical technique used for the treatment of lung cancer in France, even though this technology is mostly used by surgeons practicing in high volume institutions. ABSTRACT: Background. The minimally invasive approach (MIA) has gained popularity thanks to its efficacy and safety. Our work consisted of evaluating the diffusion of the MIA in hospitals and the variability of this approach (within and between regions). Methods. All patients who underwent limited resection or lobectomy for lung cancer in France were included from the national hospital administrative database (2013–2020). We described between-hospital differences in the MIA rate over four periods (2013–2014, 2015–2016, 2017–2018, and 2019–2020). The potential influence of the hospital volume, hospital type, and period on the adjusted MIA rate was estimated by a multilevel linear regression. Results. From 2013 to 2020, 77,965 patients underwent a lobectomy or limited resection for lung cancer. The rate of the MIA increased significantly over the four periods (50% in 2019–2020). Variability decreased over time in 7/12 regions. The variables included in the multilevel model were significantly related to the adjusted rate of the MIA. Variability between regions was considerable since 18% of the variance was due to systematic differences between regions. Conclusions. We confirm that the MIA is part of the surgical techniques used on a daily basis for the treatment of lung cancer. However, this technology is mostly used by surgeons in high volume institutions.