{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T15:22:46Z","timestamp":1770909766675,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UF Health Cancer Institute","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Lung cancer remains the leading cause of cancer-related morbidity and mortality. Despite advances in surgical management, economically disadvantaged patients experience inequalities in the receipt of treatments. We evaluated the association between socioeconomic status (SES) and type of surgery: robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and open thoracotomy. Methods: Data came from the National Cancer Database (2015\u20132022) and included Stage 0\u2013IIIa NSCLC patients. SES was measured by quartiles of median household income in the patient\u2019s zip code. Adjusted multinomial logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Among 84,931 patients with a mean age of 67.8 years, 38.4% underwent open thoracotomy, 33.3% underwent VATS, and 28.2% underwent RATS. Patients residing in the low-income areas (&lt;$46,277) were significantly less likely to undergo RATS (aOR: 0.79, 95% CI: 0.77\u20130.86) or VATS (aOR: 0.62, 95% CI: 0.59\u20130.66) compared to patients living in high-income areas (\u2265$74,063). Community hospitals were less likely to provide RATS (aOR: 0.32, 95% CI: 0.29\u20130.35) or VATS (aOR: 0.58, 95% CI: 0.54\u20130.63) than academic centers. Conclusion: Socioeconomic disadvantage is associated with lower use of minimally invasive surgical approaches for NSCLC. Efforts to expand access to advanced surgical care may be necessary to reduce treatment disparities and improve outcomes.<\/jats:p>","DOI":"10.3390\/cancers18040601","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T14:06:16Z","timestamp":1770905176000},"page":"601","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Socioeconomic Factors Associated with Receipt of Minimally Invasive Surgery for NSCLC: Evidence from the National Cancer Database"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5371-6908","authenticated-orcid":false,"given":"Shama D.","family":"Karanth","sequence":"first","affiliation":[{"name":"Division of Population Health Sciences, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA"},{"name":"University of Florida Health Cancer Center, University of Florida, Gainesville, FL 32608, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1699-7549","authenticated-orcid":false,"given":"Nimish","family":"Valvi","sequence":"additional","affiliation":[{"name":"College of Health, Department of Nutrition & Health Science, Ball State University, Muncie, IN 47306, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihika M.","family":"Shinde","sequence":"additional","affiliation":[{"name":"Division of Population Health Sciences, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA"},{"name":"University of Florida Health Cancer Center, University of Florida, Gainesville, FL 32608, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Kowalik","sequence":"additional","affiliation":[{"name":"College of Health, Department of Nutrition & Health Science, Ball State University, Muncie, IN 47306, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7809-337X","authenticated-orcid":false,"given":"Adaeze","family":"Aroh","sequence":"additional","affiliation":[{"name":"College of Health Professions, Public Health Sciences, Slippery Rock University, Slippery Rock, PA 16057, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7331-747X","authenticated-orcid":false,"given":"Hiren J.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL 32610, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael K.","family":"Gould","sequence":"additional","affiliation":[{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA 91101, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dejana","family":"Braithwaite","sequence":"additional","affiliation":[{"name":"Division of Population Health Sciences, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA"},{"name":"University of Florida Health Cancer Center, University of Florida, Gainesville, FL 32608, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"ref_1","first-page":"12","article-title":"Cancer statistics, 2024","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e1915724","DOI":"10.1001\/jamanetworkopen.2019.15724","article-title":"Comparison of Long-term Survival of Patients With Early-Stage Non\u2013Small Cell Lung Cancer After Surgery vs Stereotactic Body Radiotherapy","volume":"2","author":"Chi","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ma, J., Li, X., Zhao, S., Wang, J., Zhang, W., and Sun, G. (2021). Robot-assisted thoracic surgery versus video-assisted thoracic surgery for lung lobectomy or segmentectomy in patients with non-small cell lung cancer: A meta-analysis. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-08241-5"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.jtcvs.2013.12.045","article-title":"Fewer complications result from a video-assisted approach to anatomic resection of clinical stage I lung cancer","volume":"148","author":"Boffa","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Berjaoui, N., Lampridis, S., Patel, A., Kattar, C., Aoun, L., Santos, F., Fabbri, G., and Bille, A. (2025). An update on robot-assisted and video-assisted lobectomies for non-small cell lung cancer: A narrative review. Video-Assisted Thorac. Surg., 10.","DOI":"10.21037\/vats-24-26"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1111\/1759-7714.14938","article-title":"Perioperative outcomes of robotic-assisted versus video-assisted thoracoscopic lobectomy: A propensity score matched analysis","volume":"14","author":"Wu","year":"2023","journal-title":"Thorac. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"pkaa028","DOI":"10.1093\/jncics\/pkaa028","article-title":"Mortality for robotic- versus video-assisted lobectomy treated stage I non-small cell lung cancer patients","volume":"4","author":"Cui","year":"2020","journal-title":"JNCI Cancer Spectr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.xjon.2024.10.035","article-title":"National race and socioeconomic disparities in access to minimally invasive lung resection for early-stage lung cancer: Impact on mortality","volume":"23","author":"Sallam","year":"2024","journal-title":"JTCVS Open"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Tosi, D., Bottoni, E., and Palleschi, A. (2025). Editorial: New perspectives in robotic-assisted thoracic surgery (RATS). Front. Surg., 12.","DOI":"10.3389\/fsurg.2025.1574220"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"60","DOI":"10.21037\/vats.2017.09.01","article-title":"Robotic is better than VATS? Ten good reasons to prefer robotic versus manual VATS surgery in lung cancer patients","volume":"2","author":"Solinas","year":"2017","journal-title":"Video-Assisted Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.lungcan.2016.09.004","article-title":"Robot-assisted surgery for lung cancer: State of the art and perspectives","volume":"101","author":"Veronesi","year":"2016","journal-title":"Lung Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.21037\/ccts-20-75","article-title":"Review of the learning curve of video-assisted thoracic surgery & robotic-assisted thoracic surgery lobectomies\u2014Similarities and differences","volume":"3","author":"Paladini","year":"2021","journal-title":"Curr. Chall. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/resp.13920","article-title":"Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery","volume":"25","author":"Sihoe","year":"2020","journal-title":"Respirology"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Wang, J.-Q., and Ma, Z.-J. (2025). Impact of video-assisted thoracic surgery versus open thoracotomy on postoperative wound infections in lung cancer patients: A systematic review and meta-analysis. BMC Pulm. Med., 25.","DOI":"10.1186\/s12890-025-03589-x"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.jtcvs.2013.09.046","article-title":"Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: Results from a multihospital database (Premier)","volume":"147","author":"Swanson","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.21037\/vats-23-76","article-title":"Approaching lobectomy in a VIOLET tinted world: Video-assisted thoracoscopic surgery (VATS) vs. open thoracotomy for lobectomy","volume":"9","author":"Gulati","year":"2024","journal-title":"Video-Assisted Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1016\/j.jtcvs.2023.12.008","article-title":"Association of neighborhood socioeconomic disadvantage with use of minimally invasive resection for non\u2013small cell lung cancer","volume":"168","author":"Sakowitz","year":"2024","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"13","DOI":"10.21037\/vats.2020.02.01","article-title":"Socioeconomic, rural, and insurance-based inequities in robotic lung cancer resections","volume":"5","author":"Erhunmwunsee","year":"2020","journal-title":"Video-Assisted Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"516","DOI":"10.21037\/jtd-2024-1986","article-title":"Bridging the gap: Expanding access to minimally invasive thoracic surgery to reduce health disparities","volume":"17","author":"Zolfaghari","year":"2025","journal-title":"J. Thorac. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2801","DOI":"10.3390\/curroncol30030213","article-title":"Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States","volume":"30","author":"Halloran","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1245\/s10434-007-9747-3","article-title":"The National Cancer Data Base: A Powerful Initiative to Improve Cancer Care in the United States","volume":"15","author":"Bilimoria","year":"2008","journal-title":"Ann. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.1002\/cncr.28749","article-title":"US lung cancer trends by histologic type","volume":"120","author":"Lewis","year":"2014","journal-title":"Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.xjon.2022.07.014","article-title":"Trends of utilization and perioperative outcomes of robotic and video-assisted thoracoscopic surgery in patients with lung cancer undergoing minimally invasive resection in the United States","volume":"12","author":"Alwatari","year":"2022","journal-title":"JTCVS Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/j.juro.2012.09.033","article-title":"Disparities in Access to Hospitals with Robotic Surgery for Patients with Prostate Cancer Undergoing Radical Prostatectomy","volume":"189","author":"Kim","year":"2013","journal-title":"J. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e007409","DOI":"10.1136\/bmjopen-2014-007409","article-title":"Disparities in the receipt of robot-assisted radical prostatectomy: Between-hospital and within-hospital analysis using 2009\u20132011 California inpatient data","volume":"5","author":"Kim","year":"2015","journal-title":"BMJ Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1097\/SLA.0000000000001781","article-title":"Insurance Status, Not Race, is Associated With Use of Minimally Invasive Surgical Approach for Rectal Cancer","volume":"265","author":"Turner","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3306","DOI":"10.1007\/s00464-022-09793-8","article-title":"Factors contributing to the utilization of robotic colorectal surgery: A systematic review and meta-analysis","volume":"37","author":"Hayden","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_28","first-page":"1","article-title":"State variability in supply of office-based primary care providers: United States, 2012","volume":"151","author":"Hing","year":"2014","journal-title":"NCHS Data Brief."},{"key":"ref_29","unstructured":"Seervai, S., Shah, A., and Shah, T. (2025, November 27). Living with a Disability in America, and How Serious Illness Can Add to Them. Available online: https:\/\/www.commonwealthfund.org\/publications\/fund-reports\/2019\/apr\/challenges-living-disability-america-and-how-serious-illness-can."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1513\/AnnalsATS.201606-469OC","article-title":"Residence in Rural Areas of the United States and Lung Cancer Mortality. Disease Incidence, Treatment Disparities, and Stage-Specific Survival","volume":"14","author":"Atkins","year":"2017","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.lungcan.2014.01.008","article-title":"Treatment and survival disparities in lung cancer: The effect of social environment and place of residence","volume":"83","author":"Johnson","year":"2014","journal-title":"Lung Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.jss.2024.01.028","article-title":"Comparing Robotic, Thoracoscopic, and Open Segmentectomy: A National Cancer Database Analysis","volume":"296","author":"Caso","year":"2024","journal-title":"J. Surg. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1001\/jamasurg.2013.2750","article-title":"Massachusetts Health Care Reform and Reduced Racial Disparities in Minimally Invasive Surgery","volume":"148","author":"Loehrer","year":"2013","journal-title":"JAMA Surg."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/4\/601\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T14:25:40Z","timestamp":1770906340000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/4\/601"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["cancers18040601"],"URL":"https:\/\/doi.org\/10.3390\/cancers18040601","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]}}}