Video-assisted thoracoscopic lobectomy after neoadjuvant chemotherapy for non-small cell lung cancer: a multicenter propensity-matched study (original) (raw)
Related papers
Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer
The Journal of Thoracic and Cardiovascular Surgery, 2009
Background: The optimal surgical technique for lobectomy in lung cancer is not well defined. Proponents of video-assisted thoracic surgery (VATS) hypothesize that less trauma leads to quicker recovery, whereas those who advocate thoracotomy claim it as an oncologically superior procedure. However, a well-balanced comparison of the two procedures is lacking in the literature.
VATS is an adequate oncological operation for stage I non-small cell lung cancer☆
European Journal of Cardio-Thoracic Surgery, 2002
Objectives: This study was designed to determine the long-term prognosis of video-assisted thoracic surgery (VATS) vs. open lung resections for patients with pathological stage I non-small cell lung cancer (NSCLC). Materials and methods: The medical records of all patients who underwent lung resection for a pathological stage I NSCLC were reviewed for the period from 1990 to 1999, by screening of a database into which data were entered prospectively. There were 511 patients (430 males and 81 females) whose age averaged 63^10 years who underwent 515 lung resections. Our VATS experience began in 1993 with selected stage I patients, and since that date an average of one patient on four was managed with VATS. Lung resections consisted of 25 wedge resections or segmentectomies (seven VATS), 390 lobectomies (92 VATS), 19 bilobectomies (one VATS) and 81 pneumonectomies (ten VATS). Lymph node dissection was performed in all cases. Results: There were significantly more females ðP ¼ 0:01Þ and adenocarcinoma ðP ¼ 0:02Þ in the VATS group ðn ¼ 110Þ when compared to the open group ðn ¼ 405Þ. Tumour size averaged 4^2 cm in the open group and 3^2 cm in the VATS group ðP ¼ 0:04Þ. The distribution of T1/T2 tumours was 97/308 and 50/60, respectively ðP ¼ 0:0001Þ. At follow-up, cancer recurrence could be documented in 117 patients, with no difference of incidence between the two groups (22.5 vs. 24.5%; P ¼ 0:64). Estimated Kaplan-Meier 5-year survival rates, including the operative mortality as well as any cancer-related and unrelated death, were 62.8% (confidence interval (CI): 56.8-68.7%) vs. 62.9% (CI: 51.4-74.4%), respectively ðP ¼ 0:60Þ. The advent of VATS did not influence the patients' survival: 5-year survival rate was 63.9% (CI: 55.3-72.5%) for the period from 1990 to 1992, and 58.8% (CI: 51.7-65.9%) for the period from 1993 to 1999 ðP ¼ 0:65Þ. Subgroups survival analysis according to the T status did not show any statistically significant difference between the two groups. Conclusions: VATS lung resection with lymph node dissection achieved a 5-year survival similar to that achieved by the conventional approach. VATS is a valuable option for the management of selected patients with an early-stage NSCLC.
Current Challenges in Thoracic Surgery, 2020
Background: Lung cancer is the third most diagnosed tumor in Italy and is the leading cause of cancer death in males and the third in females. Video-assisted thoracoscopic surgery lobectomy (VATS-L) represents the gold standard for the treatment of early-stage non-small cell lung cancer (NSCLC). The aim of the study is to evaluate the short-and long-term outcomes of NSCLC patients with stage IIIA N2, treated with preoperative chemotherapy (CHT) followed by VATS lobectomy. Methods: A retrospective analysis was performed on patients with NSCLC, who underwent VATS-L with (Group A) or without (Group B) neoadjuvant or induction CHT. Out of 6,846 patients enroled in the VATS Group National Registry, we selected 386 patients with stage IIIA NSCLC (pT1-2, N2). Forty-two patients (10.9%) underwent neoadjuvant or induction CHT and then VATS-L (Group A). The remaining 344 patients (89.1%) underwent VATS-L only (Group B). Results: The outcomes evaluation between Group A and Group B showed respectively: (I) average length of stay, 9.4 vs. 8.5 days; (II) average duration of pleural drainage, 4.7 vs. 4.6 days; (III) incidence of pneumonia, 4.8% vs. 4.1%; (IV) mortality at 30 days, 0% vs. 0.3%; (V) general mortality, 9.5% vs. 7.3%; (VI) postoperative bleeding necessitating re-intervention and blood transfusion, 4.8% vs. 0.3% and 0% vs. 2.9%; (VII) atrial fibrillation, 16.7% vs. 7.5%; (VIII) prolonged air leaks, 11.9% vs. 7%; (IX) respiratory failure, 0% vs. 0.3%. Conclusions: Our study confirms that VATS-L in patients with stage IIIA N2 NSCLC treated with neoadjuvant or induction CHT is feasible, oncologically effective and sufficiently safe.
Journal of Personalized Medicine
Primary lung cancer is a devastating disease with high morbidity and mortality rates. Patients with a previous oncological history may present with multiple comorbidities, unique clinical features, and unique outcomes after surgical intervention for primary lung cancer. This study aimed to compare the clinical features and outcomes of patients with a previous oncological history who underwent video-assisted thoracoscopic surgery (VATS) or open surgery (OS) for primary lung cancer. A retrospective analysis was conducted on 84 patients with a previous oncological history who underwent surgical intervention for primary lung cancer between January 2018 and January 2023. Among them, 55 patients underwent VATS, while 29 patients underwent OS. Demographic and clinical characteristics, perioperative variables, and postoperative outcomes of the two surgical groups were collected and compared. Most of the 84 patients were women (58.4%) with a high smoking prevalence (44.1%) and a median of 32...
2007
This meta-analysis sought to determine whether videoassisted thoracic surgery (VATS) improves clinical and resource outcomes compared with thoracotomy (OPEN) in adults undergoing lobectomy for nonsmall cell lung cancer. Methods: A comprehensive search was undertaken to identify all randomized (RCT) and nonrandomized (non-RCT) controlled trials comparing VATS with OPEN thoracotomy available up to April 2007. The primary outcome was survival. Secondary outcomes included any other reported clinical outcome and resource utilization. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences (SMD), and their 95% confidence intervals (95% CI) were analyzed as appropriate. Results: Baseline prognosis was more favorable for VATS (more females, smaller tumor size, less advanced stage, histology associated with peripheral location and with more indolent disease) than for OPEN in non-RCTs, but not RCT. Postoperative complications were significantly reduced in the VATS group compared with OPEN surgery when both RCT and non-RCT were considered in aggregate (OR 0.48, 95% CI 0.32-0.70). Although overall blood loss was significantly reduced with VATS compared with OPEN (Ϫ80 mL, 95% CI Ϫ110 to Ϫ50 mL), the incidence of excessive blood loss (generally defined as Ͼ500 mL) and incidence of re-exploration for bleeding was not significantly reduced. Pain measured via visual analog scales (10-point VAS) was significantly reduced by Ͻ1 point on day 1, by Ͼ2 points at 1 week, and by Ͻ1 point at week 2 to 4. Similarly, analgesia requirements were significantly reduced in the VATS group. Postoperative vital capacity was significantly improved (WMD 20, 95% CI 15-25), and at 1 year was significantly greater for VATS versus OPEN surgery (WMD 7, 95% CI 2-12). The incidence of patients reporting limited activity at 3 months was reduced (OR 0.04, 95% CI 0.00-0.82), and time to full activity was significantly reduced in the VATS versus OPEN surgery (WMD Ϫ1.5, 95% CI Ϫ2.1 to Ϫ0.9). Overall patient-reported physical function scores did not differ between groups at 3 years follow-up. Hospital length of stay was significantly reduced by 2.6 days despite increased 16 minutes of operating time for VATS versus OPEN. The incidence of cancer recurrence (local or distal) was not significantly different, but chemotherapy delays were significantly reduced for VATS versus OPEN (OR 0.15, 95% CI 0.06-0.38). The need for chemotherapy reduction was also decreased (OR 0.37, 95% CI 0.16-0.87), and the number of patients who did not receive at least 75% of their planned chemotherapy without delays were reduced (OR 0.41, 95% CI 0.18-0.93). The risk of death was not significantly reduced when RCTs were considered alone; however, when non-RCTs (n ϭ 18) were included, the risk of death at 1 to 5 years was significantly reduced (OR 0.72, 95% CI 0.55-0.94; P ϭ 0.02) for VATS versus OPEN. Stage-specific survival to 5 years was not significantly different between groups. Conclusions: This meta-analysis suggests that there may be some short term, and possibly even long-term, advantages to performing lung resections with VATS techniques rather than through conventional thoracotomy. Overall, VATS for lobectomy may reduce acute and chronic pain, perioperative morbidity, and improve delivery of adjuvant therapies, without a decrease in stage specific long-term survival. However, the results are largely dependent on non-RCTs, and future adequately powered randomized trials with long-term follow-up are encouraged.
The Annals of thoracic surgery, 2015
The short-term superiority of video-assisted thoracoscopic surgery lobectomy compared with open lobectomy for early-stage lung cancer has been suggested by single-institution studies. Lack of equipoise limits the feasibility of a randomized study to confirm this. The hypothesis of this study (CALGB 31001) was that VATS lobectomy results in shorter length of hospital stay and fewer complications compared with open lobectomy in stages I and II non-small cell lung cancer in a multi-institutional setting. Five hundred nineteen patients whose tumors had been collected as part of CALGB 140202 (lung cancer tissue bank) were eligible. Propensity-scoring using age, race, sex, performance status, comorbidities, histology, tumor stage, and size as independent variables was used to create a 1:1 matched group of 175 pairs of patients. McNemar's test for binary variables and Wilcoxon signed-rank test for continuous variables were used to assess differences in length of hospital stay, complica...
The Journal of Thoracic and Cardiovascular Surgery, 2006
Background: Although video-assisted thoracic surgery (VATS) has been in use for more than a decade, its application to major lung resection for lung cancer is still not widely practiced. The success of a cancer operation is judged by the long-term survival of the treated patients. Therefore, the goal of the present study was to evaluate long-term outcomes associated with various video-assisted lobectomy techniques and conventional surgery in patients with peripheral non-small cell lung cancer less than or equal to 2 cm in diameter (stage IA).
Vats lobectomy for lung cancer. What has been the evolution over the time
Frontiers in Oncology, 2024
Video assisted thoracic surgery (VATS) lobectomy is the treatment of choice for early-stage lung cancer. It is safe and effective compared to open surgery, as demonstrated by a large body of scientific evidence over the last few decades. VATS lobectomy's evolution was driven by the need to decrease post-operative pain by reducing the extent of surgical accesses, maintaining the same oncological efficacy of open lobectomy with less invasiveness. VATS lobectomy just turned 30 years old, evolving and changing significantly from its origins. The aim of this mini review is to retrace the history, starting from a multiport approach to a single port approach. At the end of this mini review, we will discuss the advanced and the future challenges of the technique that has revolutionized thoracic surgery.