Abstract
Video‐assisted thoracoscopic surgery (VATS) is regarded as the standard treatment for lung cancer. However, the feasibility and safety of VATS for lung cancer after neoadjuvant chemoradiotherapy (CRT) is unclear. This study evaluated the feasibility and safety of VATS in patients who had received neoadjuvant CRT.MethodsBetween January 2008 and December 2017, 85 patients who were administered neoadjuvant CRT and underwent anatomic lung resection were enrolled. Fifty‐nine patients underwent open thoracotomy and 26 patients underwent VATS. The clinical characteristics and perioperative outcomes were reviewed.ResultsIn six of the initial 32 patients who underwent VATS, the procedure was converted to thoracotomy. Adjacent structural invasion (33.9% vs. 11.5%; P = 0.037) and combined resection (16.9% vs. 0%; P = 0.025) were higher in the open group than in the VATS group. Surgical duration was higher in the open group than in the VATS group (203.86 ± 65.97 vs. 173.27 ± 59.87 minutes; P = 0.046). With regard to postoperative outcomes, the length of the hospital stay was longer in the open group compared to the VATS group (14.46 ± 16.94 vs. 8.62 ± 4.72 days; P = 0.017). There was no significant difference in the three‐year disease‐free survival (69.3% vs. 67.9%; P = 0.879) or overall survival rates (76.6% vs. 61.9%; P = 0.516).ConclusionIn selected patients, VATS pulmonary resection after neoadjuvant CRT showed results comparable to that of thoracotomy in terms of postoperative outcomes, operative morbidities, and survival rate.
Highlights
Since the 1990s, video-assisted thoracoscopic surgery (VATS) has become a popular method for performing pulmonary resection for lung cancer and is regarded as the standard treatment for early-stage non-small cell lung cancer (NSCLC).[1,2] VATS lobectomy offers more advantages than thoracotomy lobectomy in terms of short-term postoperative outcomes, including less postoperative pain, faster postoperative recovery, greater preservation of pulmonary function, and lower perioperative morbidity.[3]VATS lobectomy is equivalent to thoracotomy in terms of oncologic outcomes, including survival and recurrence rates.[4,5]Recent studies have suggested that surgical resection following neoadjuvant chemotherapy for patients with locally advanced NSCLC can significantly improve the complete surgical resection (R0) rate and long-term survival.[2,6,7] the feasibility and clinical efficacy of performing VATS pulmonary resection after neoadjuvant CRT remains controversial.[3,8] The technical difficulties
A total of 85 patients were enrolled in the study: 59 patients (69.4%) who underwent thoracotomy were categorized as the Open group; and 26 patients (30.6%) who successfully underwent VATS were categorized as the VATS group (Fig 1)
VATS was converted to thoracotomy in five patients because of nononcologic causes (83.3%) and in one patient because of an oncologic cause (16.7%)
Summary
Since the 1990s, video-assisted thoracoscopic surgery (VATS) has become a popular method for performing pulmonary resection for lung cancer and is regarded as the standard treatment for early-stage non-small cell lung cancer (NSCLC).[1,2] VATS lobectomy offers more advantages than thoracotomy lobectomy in terms of short-term postoperative outcomes, including less postoperative pain, faster postoperative recovery, greater preservation of pulmonary function, and lower perioperative morbidity.[3]VATS lobectomy is equivalent to thoracotomy in terms of oncologic outcomes, including survival and recurrence rates.[4,5]Recent studies have suggested that surgical resection following neoadjuvant chemotherapy for patients with locally advanced NSCLC can significantly improve the complete surgical resection (R0) rate and long-term survival.[2,6,7] the feasibility and clinical efficacy of performing VATS pulmonary resection after neoadjuvant CRT remains controversial.[3,8] The technical difficulties. Since the 1990s, video-assisted thoracoscopic surgery (VATS) has become a popular method for performing pulmonary resection for lung cancer and is regarded as the standard treatment for early-stage non-small cell lung cancer (NSCLC).[1,2]. VATS lobectomy offers more advantages than thoracotomy lobectomy in terms of short-term postoperative outcomes, including less postoperative pain, faster postoperative recovery, greater preservation of pulmonary function, and lower perioperative morbidity.[3]. VATS lobectomy is equivalent to thoracotomy in terms of oncologic outcomes, including survival and recurrence rates.[4,5]. Recent studies have suggested that surgical resection following neoadjuvant chemotherapy for patients with locally advanced NSCLC can significantly improve the complete surgical resection (R0) rate and long-term survival.[2,6,7]. The feasibility and clinical efficacy of performing VATS pulmonary resection after neoadjuvant CRT remains controversial.[3,8].
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