Does VATS Lobectomy Avoid Delay and Increase Compliance in Adjuvant Chemotherapy?
İlker KOLBAŞ1,Çağatay TEZEL1,Akın ÖZTÜRK2,Levent ALPAY3,Serdar EVMAN3
1Deparment of Thoracic Surgery, İstanbul Sultan Abdulhamid Han Training and Research Hospital, İstanbul-Türkiye
2Deparment of Medical Oncology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul-Türkiye
3Deparment of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul-Türkiye
DOI : 10.5505/tjo.2022.3534 OBJECTIVE
Adjuvant 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.

Clinical 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.

Eighty-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).

Besides 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. Keywords : Adjuvant chemotherapy; adjuvant navelbine international trialist association; chemotherapy compliance; lung cancer; thoracotomy; video-assisted thoracic surgery