{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T14:50:33Z","timestamp":1774968633161,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Minimally invasive (MI) pulmonary metastasectomy may improve access in frail patients who are at high\u2010risk for complications after thoracotomy. We compared postoperative complications among frail and non\u2010frail patients undergoing pulmonary metastasectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Nationwide Readmissions Database (2017\u20132019) identified adult patients who underwent pulmonary metastasectomy. Frailty was determined using Johns Hopkins Adjusted Clinical Groups indicator. Independent propensity\u2010score matches were performed for the open and MI cohorts. Odds ratio (OR) and incidence rate (IRR) were used to compare morbidity and length of stay (LOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 8778 patients underwent pulmonary metastasectomy, of which 3.1% (270\/8778) were frail. In the open cohort after propensity\u2010score matching (98\u2010matched pairs), frail patients had more complications (OR 2.1;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001) and increased LOS (IRR 2.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), both of which did not improve with a sublobar resection. In the MI cohort (167\u2010matched pairs), frailty was associated with increased morbidity (OR 2.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and increased LOS (IRR 2.8;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), but both were mitigated by sublobar resection (morbidity OR 0.44;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005; LOS IRR 0.66;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A MI sublobar resection significantly mitigates the risk of pulmonary metastasectomy in frail patients. Thoracotomy and lobectomy should be approached cautiously in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70078","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T10:32:44Z","timestamp":1757068364000},"page":"1173-1181","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Safety of Minimally Invasive Sublobar Pulmonary Metastasectomy in the Frail Patient"],"prefix":"10.1002","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0206-8593","authenticated-orcid":false,"given":"Hannah","family":"Sidhu","sequence":"first","affiliation":[{"name":"Keck School of Medicine of USC Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences Keck School of Medicine of USC Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graeme M.","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Surgery, Keck School of Medicine of USC Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Harano","sequence":"additional","affiliation":[{"name":"Surgery, Keck School of Medicine of USC Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean C.","family":"Wightman","sequence":"additional","affiliation":[{"name":"Surgery, Keck School of Medicine of USC Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1925-6746","authenticated-orcid":false,"given":"Scott M.","family":"Atay","sequence":"additional","affiliation":[{"name":"Surgery, Keck School of Medicine of USC Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2790-4945","authenticated-orcid":false,"given":"Anthony W.","family":"Kim","sequence":"additional","affiliation":[{"name":"Surgery, Keck School of Medicine of USC Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brooks V.","family":"Udelsman","sequence":"additional","affiliation":[{"name":"Surgery, Keck School of Medicine of USC Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0960-7404(01)00013-5"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(97)70397-0"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e3181dcf59c"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.15113"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-2019-pm-13"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaa405"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2010.08.009"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2010.01.028"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/56.3.M146"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.11.035"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-11715-4"},{"key":"e_1_2_10_13_1","volume-title":"Healthcare Cost and Utilization Project (HCUP)","author":"HCUP Nationwide Readmissions Database (NRD)","year":"2017"},{"key":"e_1_2_10_14_1","unstructured":"The Johns Hopkins ACG\u00ae System. \u201cExcerpt From Technical Reference Guide Version 9.0 \u201d published2009 https:\/\/www.healthpartners.com\/ucm\/groups\/public\/@hp\/@public\/documents\/documents\/dev_057914.pdf."},{"issue":"3","key":"e_1_2_10_15_1","first-page":"333","article-title":"The Influence of Frailty on Perioperative Outcomes in Patients Undergoing Surgical Resection of Liver Metastases: A Nationwide Readmissions Database Study","volume":"36","author":"Shahrestani S.","year":"2023","journal-title":"Annals of Gastroenterology"},{"issue":"10","key":"e_1_2_10_16_1","first-page":"392","article-title":"Identifying Frail Older People Using Predictive Modeling","volume":"18","author":"Sternberg S. A.","year":"2012","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_10_17_1","volume-title":"Development and Evaluation of the Johns Hopkins University Risk Adjustment Models for Medicare+Choice Plan Payment","author":"Abrams C.","year":"2003"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2015.5085"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_2_10_20_1","volume-title":"Healthcare Cost and Utilization Project (HCUP)","author":"HCUP Elixhauser Comorbidity Software Refined for ICD\u201010\u2010CM, v2021.1","year":"2024"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.08.078"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2021.07.030"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2016.09.065"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2020.11.004"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.36255\/exon-publications.metastasis.pulmonary-metastases"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2023.107284"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2021.01.143"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70078","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.70078","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70078","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T21:42:38Z","timestamp":1771278158000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70078"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,5]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/jso.70078"],"URL":"https:\/\/doi.org\/10.1002\/jso.70078","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,5]]},"assertion":[{"value":"2025-07-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}