Does VATS Lobectomy Avoid Delay and Increase Compliance in Adjuvant Chemotherapy?

English (OpenAlex)

OBJECTIVEAdjuvant chemotherapy compliance and full dose delivery of agents are superior after videothoracoscopic Video-Assisted Thoracic Surgery lobectomy (VATS-L) for operable non-small cell lung carcinoma (NSCLC), compared with thoracotomy.Our aim was determining the role of VATS-L on inception timing and percentage of patients provided with the planned chemotherapy regimen. METHODSClinical files of patients undergoing pulmonary resection for NSCLC between January 2010 and January 2018 were reviewed retrospectively.Analyses were performed only on patients receiving sole post-operative adjuvant chemotherapy subsequent to the final pathology.Chemotherapy protocol was planned according to Adjuvant Navelbine International Trialist Association trial.Analyzed variables were the duration between operation and initial chemotherapy day, with the planned and received chemotherapy doses.Patients with positive N2 nodes necessitating adjuvant RT were excluded from the study. RESULTSEighty-four patients underwent adjuvant chemotherapy for NSCLC, either after videothoracoscopic surgery (n=36) or thoracotomy (n=48).Patients undergoing VATS-L had a shorter mean length of hospital stay (4.1 versus 7.3 days; p<0.001), which lead significantly reduced time delay on chemotherapy commencement (29.1 versus 36.9 days; p<0.005).VATS-L group received 82.9% of planned Cisplatin and 81.7% of Navelbine doses.In thoracotomy group, compliance to planned doses of Cisplatin and Navelbine was 77.6% and 75.0%, respectively.Tolerance for both drugs was increased in the VATS-L group (Cisplatin p=0.004;Navelbine p=0.004). CONCLUSIONBesides the known advantages of VATS-L over conventional open surgery, our data demonstrated that it also allows more complete and rapid adjuvant chemotherapy, in terms of treatment initiation timing and compliance, by enabling quick post-operative recovery.