Bridging the gap: expanding access to minimally invasive thoracic surgery to reduce health disparities

The application of minimally invasive surgery has transformed outcomes for cardiothoracic surgery. Lu and colleagues expand on this concept in their publication: “Minimally invasive surgery, precise anesthesia and effective analgesia are crucial for walking within 1 hour after lung surgery” (1). The authors concluded that patients with access to intercostal nerve blocks and minimally invasive video-assisted thoracoscopic surgery (VATS) recovered quicker than patients receiving intravenous analgesia or open surgical techniques. In their paper, the authors use the ability of the patient to walk in the post-operative period as a surrogate measure for autonomous activity, highlighting milestones of patient progression in the recovery period following minimally invasive surgery.

While it is noteworthy to document that patients with access to hospital centers with minimally invasive surgical techniques have improved post-operative outcomes, it is important to recognize that barriers exist which may prevent patients with lower socioeconomic backgrounds to be treated at a minimally invasive resection center. It has been reported that patients from less affluent socioeconomic backgrounds and those receiving treatment at a community hospital have a lower likelihood of receiving minimally invasive resection (2). Of equal importance, we must recognize that centers accessible to patients from lower socioeconomic backgrounds may not have specialized anesthesiologists with capabilities of offering intercostal nerve blocks compared to intravenous analgesia.

While we appreciate the report from Lu et al., we recognize its limitations to account for disparities in race and socioeconomic status that may lead patients to have reduced access to comprehensive surgical services, including minimally invasive surgery. Inequalities in insurance status, race, and socioeconomics has been associated with inequalities in incidence, screening, and care for lung cancer (3,4). Instead, the statements presented by Lu and colleagues demonstrate the need to improve access to high-volume minimally invasive surgical centers to minimize differences in surgical outcomes and reduce income-based disparities.

Studies have reported on inequities in access to minimally invasive thoracic surgical techniques based on patient demographics. While we recognize the importance of the results presented by Lu and colleagues, we hope to emphasize that expanding access to minimally invasive surgical centers to reduce disparities in outcomes post-surgery remains a priority for thoracic surgeons.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2024-1986/coif). M.B.A. serves as an unpaid editorial board member of Journal of Thoracic Disease from August 2024 to July 2026. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Lu D, Zhou C, Zhang Y, et al. Minimally invasive surgery, precise anesthesia and effective analgesia are crucial for walking within 1 hour after lung surgery. J Thorac Dis 2024;16:5792-801. [Crossref] [PubMed]
2. Sakowitz S, Bakhtiyar SS, Curry J, et al. Association of neighborhood socioeconomic disadvantage with use of minimally invasive resection for non-small cell lung cancer. J Thorac Cardiovasc Surg 2024;168:1270-1280.e1. [Crossref] [PubMed]
3. Sidorchuk A, Agardh EE, Aremu O, et al. Socioeconomic differences in lung cancer incidence: a systematic review and meta-analysis. Cancer Causes Control 2009;20:459-71. [Crossref] [PubMed]
4. Gould MK, Schultz EM, Wagner TH, et al. Disparities in lung cancer staging with positron emission tomography in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. J Thorac Oncol 2011;6:875-83. [Crossref] [PubMed]