What is the extent of the advantage of video-assisted thoracoscopic surgical resection over thoracotomy in terms of delivery of adjuvant chemotherapy following non-small-cell lung cancer resection?
Teh E., Abah U., Church D., Saka W., Talbot D., Belcher E., Black E.
OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) lobectomy for early stage non-small cell lung cancer (NSCLC) is a safe and effective alternative to open lobectomy. Adjuvant chemotherapy is part of the treatment recommended for patients with performance status (PS) 0-1 following resection of NSCLC of stages T1-3 N1-2 M0 and T2-3 N0 M0. If VATS reduces morbidity, does it help delivery of postoperative chemotherapy? We studied our data to compare the delivery and toxicity of chemotherapy in patients following VATS or open lung resections. METHODS: We performed a retrospective study of all patients who had resection of primary NSCLC in a single surgical centre between October 2008 and August 2013. Surgical and chemotherapy databases were reviewed to extract data on patient characteristics, operative details, pathological stage, chemotherapy delivery and toxicity. RESULTS: Three hundred and twenty-three resections were undertaken for NSCLC; 142 (44%) underwent VATS resection and 181 (56%) open thoracotomy; 16 (11.3%) and 28 (15.5%) of each group received adjuvant chemotherapy, respectively. Patient demographics and tumour stage were as follows: median age (range) was 65.5 (44-77) vs 67.5 (49-76); male: 43.8 vs 50% (P = 1.0); Stage I/II 75 vs 76.9%; Stage III 12.5 vs 30.8%; pre-chemotherapy PS 0 75 vs 78.2% for VATS and thoracotomy groups, respectively. All patients received platinum/vinorelbine therapy. Chemotherapy was initiated significantly earlier in the VATS group (mean 55.7 ± 3.1 vs 68.2 ± 4.3 days, P = 0.046); 68.8% of patients in the VATS group completed four cycles of chemotherapy compared with 60.1% in the open group (P = 0.75). There was a non-significant trend towards reduction in Grade 3/4 haematological toxicity in the VATS group compared with the open group (12.5 vs 39.3%, P = 0.09). CONCLUSIONS: Adjuvant chemotherapy was started significantly earlier in patients following VATS lung resections for NSCLC compared with thoracotomy. There was also a trend towards improved tolerance with more complete courses and reduced haematological toxicity.