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Minimally invasive surgery (MIS) for cT4N0-1M0 NSCLC is safe, does not compromise survival rates, and results in shorter hospital stays compared with open surgery, according to a study in the European Journal of Cardio-Thoracic Surgery. To analyze national trends and outcomes of MIS for cT4 cancers, Jorge Humberto Rodriguez-Quintero, MD, and colleagues identified patients with cT4N0-1M0 NSCLC in the 2010-2019 National Cancer Database. Of 3,715 patients, 64.1% underwent open resection, while 35.9% had minimally invasive resections (31.5% robotic-assisted and 68.5% video-assisted). Patients with higher incomes (≥$40,227) and those treated at academic hospitals were more likely to undergo MIS. Conversely, patients with clinically node-positive status and those who received neoadjuvant therapy were less likely to have MIS. The researchers used propensity score analysis to match patient groups and found that patients undergoing MIS had a shorter median hospital stay (5 vs 6 days) compared to those with open resection, but there were no significant differences in 30-day readmissions or 30- and 90-day mortality between the groups. The researchers concluded that MIS is a viable option for treating cT4N0-1M0 NSCLC.