Original article
General thoracic
Thoracoscopic Lobectomy Facilitates the Delivery of Chemotherapy after Resection for Lung Cancer

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.
https://doi.org/10.1016/j.athoracsur.2006.12.029Get rights and content

Background

We conducted a study of patients who underwent anatomic resection with adjuvant chemotherapy to determine if thoracoscopic lobectomy enables more effective administration of adjuvant chemotherapy than lobectomy by thoracotomy.

Methods

We reviewed the outcomes of 100 consecutive patients with non-small cell lung cancer (NSCLC) who underwent lobectomy and received adjuvant chemotherapy (1999 to 2004). The variables analyzed were time to initiation of chemotherapy, percentage of planned regimen received, number of delayed or reduced chemotherapy doses, toxicity grade, length of hospitalization, chest tube duration, 30-day mortality, and major complications (pneumonia, respiratory failure, atrial fibrillation). The χ2 test and Student t test were used to compare dichotomous and continuous variables, respectively.

Results

Complete resection was performed by thoracotomy in 43 patients and by thoracoscopy in 57 (no conversions). All patients received adjuvant chemotherapy, and 20 (20%) received adjuvant radiation therapy: 13 (30%) of 43 in the thoracotomy group and 7 (12%) of 57 in the thoracoscopy group (p = 0.04). Patients undergoing thoracoscopic lobectomy had significantly fewer delayed (18% versus 58%, p < 0.001) and reduced (26% versus 49%, p = 0.02) chemotherapy doses. A higher percentage of patients undergoing thoracoscopic resection received 75% or more of their planned adjuvant regimen without delayed or reduced doses (61% versus 40%, p = 0.03). There were no significant differences in time to initiation of chemotherapy or toxicity. Patients undergoing a thoracoscopic lobectomy had a shorter median length of hospitalization (4 days versus 5 days, p = 0.02).

Conclusions

Thoracoscopy was associated with an overall higher compliance rate and fewer delayed or reduced doses of chemotherapy in patients receiving adjuvant chemotherapy.

Section snippets

Patient Selection

A retrospective analysis was performed of 100 consecutive patients with NSCLC who received adjuvant therapy (chemotherapy with or without radiation therapy) after lobectomy at Duke University Medical Center between January 1, 1999 and July 1, 2004. The study received Institutional Review Board approval in November 2005, with individual patient consent being waived. Patients were excluded if they received their adjuvant therapy at an outside institution (n = 22).

The choice of postoperative

Results

All patients received adjuvant chemotherapy, which generally consisted of a platinum-based agent combined with either a taxane or vinca alkaloid. The chemotherapy regimens did not differ significantly between the two groups (Table 1). In addition to chemotherapy, 20 patients (20%) also received adjuvant combination radiation therapy: 13 patients (30%) in the thoracotomy group and 7 (12%) in the thoracoscopy group (p = 0.04). A significantly higher percentage of patients received combination

Comment

Advantages of a thoracoscopic approach to anatomic lung resection include decreased blood loss [20], decreased pain [2, 5, 11, 20], shorter length of hospitalization and chest tube duration [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11], more rapid return to preoperative activity [2, 5, 20], preserved postoperative pulmonary function [21, 22], decreased inflammatory response (which may confer superior immunologic function) [4, 11], and fewer overall complications [3, 6]. These benefits were achieved with

References (27)

  • M. Nakata et al.

    Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy

    Ann Thorac Surg

    (2000)
  • M.W. Onaitis et al.

    Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients

    Ann Surg

    (2006)
  • S.J. Swanson et al.

    Results of CALGB 39802: feasibility of VATS lobectomy for lung cancer

    Proc Am Soc Clin Oncol

    (2002)
  • Cited by (270)

    • Neurological complications of lung cancer

      2022, Neurological Complications of Systemic Cancer and Antineoplastic Therapy
    View all citing articles on Scopus
    View full text