A Minimally Invasive Approach to Lobectomy After Induction Therapy Does Not Compromise Survival. The Annals of thoracic surgery Jeffrey Yang, C. F., Nwosu, A. n., Mayne, N. R., Wang, Y. Y., Raman, V. n., Meyerhoff, R. R., D'Amico, T. A., Berry, M. F. 2019


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