A Minimally Invasive Approach to Lobectomy After Induction Therapy Does Not Compromise Survival.

Abstract

The objective of this study was to evaluate the impact of a VATS approach on outcomes in patients who underwent lobectomy after induction therapy.Outcomes of patients with T2-T4, N0, M0 and T1-T4, N1-N2, M0 non-small-cell lung cancer (NSCLC) who received induction chemotherapy or chemoradiation followed by lobectomy in the National Cancer Data Base (NCDB) (2010-2014) were assessed using Kaplan-Meier, propensity score-matched, multivariable logistic regression and Cox proportional hazards analyses.In the NCDB, 2,887 lobectomy patients met inclusion criteria (VATS 676 [23%], Thoracotomy 2,211 [77%]). Of the VATS cases, patients who underwent induction chemoradiation were more likely to undergo conversion (aOR 1.70, p = 0.05). Compared to an open approach, VATS was associated with decreased length of stay (median: 5 days vs 6 days, P < 0.001) and no significant differences in 30-day mortality (VATS [1.5% (n=10)] vs open [2.6% (n=58)]; P=0.13) and 90-day mortality (VATS [3.7% (n=25)] vs open [5.6% (n=124)]; P=0.14). There were no significant differences in 5-year survival between the VATS and open groups in both the entire cohort (VATS [50.3%] vs open [52.3%]; P=0.83) and in a propensity score-matched analysis of 876 patients; furthermore, a VATS approach was also not associated with worse survival in multivariable analysis (HR = 1.02; 95% CI [0.86, 1.20]; P = 0.83).In this national analysis, a VATS approach for lobectomy in patients who received induction therapy for locally advanced NSCLC was not associated with worse short-term or long-term outcomes when compared to an open approach.

View details for DOI 10.1016/j.athoracsur.2019.09.065

View details for PubMedID 31733187