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Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer.

Publication ,  Journal Article
Yang, C-FJ; Meyerhoff, RR; Mayne, NR; Singhapricha, T; Toomey, CB; Speicher, PJ; Hartwig, MG; Tong, BC; Onaitis, MW; Harpole, DH; D'Amico, TA ...
Published in: Eur J Cardiothorac Surg
June 2016

OBJECTIVES: Video-assisted thoracoscopic (VATS) lobectomy is increasingly accepted for the management of early-stage non-small cell lung cancer (NSCLC), but its role for locally advanced cancers has not been as well characterized. We compared outcomes of patients who received induction therapy followed by lobectomy, via VATS or thoracotomy. METHODS: Perioperative complications and long-term survival of all patients with NSCLC who received induction chemotherapy (ICT) (with or without induction radiation therapy) followed by lobectomy from 1996-2012 were assessed using Kaplan-Meier and Cox proportional hazard analysis. Propensity score-matched comparisons were used to assess the potential impact of selection bias. RESULTS: From 1996 to 2012, 272 patients met inclusion criteria and underwent lobectomy after ICT: 69 (25%) by VATS and 203 (75%) by thoracotomy. An 'intent-to-treat' analysis was performed. Compared with thoracotomy patients, VATS patients had a higher clinical stage, were older, had greater body mass index, and were more likely to have coronary disease and chronic obstructive pulmonary disease. Induction radiation was used more commonly in thoracotomy patients [VATS 28% (n = 19) vs open 72% (n = 146), P < 0.001]. Thirty-day mortality was similar between the VATS [3% (n = 2)] and open [4% (n = 8)] groups (P = 0.69). Seven (10%) of the VATS cases were converted to thoracotomy due to difficulty in dissection from fibrotic tissue and adhesions (n = 5) or bleeding (n = 2); none of these conversions led to perioperative deaths. In univariate analysis, VATS patients had improved 3-year survival compared with thoracotomy (61% vs 43%, P = 0.010). In multivariable analysis, the VATS approach showed a trend towards improved survival, but this did not reach statistical significance (hazard ratio, 0.56; 95% confidence interval, 0.32-1.01; P = 0.053). Moreover, a propensity score-matched analysis balancing patient characteristics demonstrated that the VATS approach had similar survival to an open approach (P = 0.56). CONCLUSIONS: VATS lobectomy in patients treated with induction therapy for locally advanced NSCLC is feasible and effective and does not appear to compromise oncologic outcomes.

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Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

June 2016

Volume

49

Issue

6

Start / End Page

1615 / 1623

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Thoracotomy
  • Thoracic Surgery, Video-Assisted
  • Retrospective Studies
  • Respiratory System
  • Propensity Score
  • Pneumonectomy
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged
 

Citation

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Yang, C.-F., Meyerhoff, R. R., Mayne, N. R., Singhapricha, T., Toomey, C. B., Speicher, P. J., … Berry, M. F. (2016). Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer. Eur J Cardiothorac Surg, 49(6), 1615–1623. https://doi.org/10.1093/ejcts/ezv428
Yang, Chi-Fu Jeffrey, Robert Ryan Meyerhoff, Nicholas Ryan Mayne, Terry Singhapricha, Christopher B. Toomey, Paul J. Speicher, Matthew G. Hartwig, et al. “Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer.Eur J Cardiothorac Surg 49, no. 6 (June 2016): 1615–23. https://doi.org/10.1093/ejcts/ezv428.
Yang C-FJ, Meyerhoff RR, Mayne NR, Singhapricha T, Toomey CB, Speicher PJ, et al. Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer. Eur J Cardiothorac Surg. 2016 Jun;49(6):1615–23.
Yang, Chi-Fu Jeffrey, et al. “Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer.Eur J Cardiothorac Surg, vol. 49, no. 6, June 2016, pp. 1615–23. Pubmed, doi:10.1093/ejcts/ezv428.
Yang C-FJ, Meyerhoff RR, Mayne NR, Singhapricha T, Toomey CB, Speicher PJ, Hartwig MG, Tong BC, Onaitis MW, Harpole DH, D’Amico TA, Berry MF. Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer. Eur J Cardiothorac Surg. 2016 Jun;49(6):1615–1623.
Journal cover image

Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

June 2016

Volume

49

Issue

6

Start / End Page

1615 / 1623

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Thoracotomy
  • Thoracic Surgery, Video-Assisted
  • Retrospective Studies
  • Respiratory System
  • Propensity Score
  • Pneumonectomy
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged