Abstract
BackgroundVideo‐assisted thoracoscopic (VATS) surgery contributes to improved survival, adjuvant chemotherapy delivery and less postoperative complications. Nonintubated thoracic surgery (NITS) VATS procedures improves immunological responses in lung cancer patients; however, there is no data regarding adjuvant chemotherapy delivery effectiveness following NITS lobectomies. In this study, we aimed to compare protocol compliance and toxic complications during adjuvant chemotherapy after intubated and nonintubated VATS lobectomies in non‐small cell lung cancer (NSCLC).MethodsWe retrospectively reviewed the medical records of 66, stage IB–IIIB NSCLC patients who underwent intubated or nonintubated VATS lobectomy and received adjuvant chemotherapy.ResultsA total of 38 patients (17 males, mean age 64 years) underwent conventional VATS and 28 (7 males; mean age 63 years) uniportal VATS NITS. Both groups had comparable demographic data, preoperative pulmonary function, and Eastern Cooperative Oncology Group (ECOG) status. Among the intubated and nonintubated patients, 82% and 75% were diagnosed with adenocarcinoma, respectively. The incidence of adenocarcinoma and squamous cell carcinoma cases were similar in both groups; however, the pathological staging showed significant differences, as 5 (18%) nonintubated patients had stage IB lung cancer, compared with the intubated group (P = 0.01). Further distribution of stages was similar between the groups. We observed significant differences in chest tube duration and operation time in the nonintubated group (P < 0.01). Among nonintubated patients, 92% completed the planned chemotherapy protocol, compared to 71% of the intubated group (P = 0.035). Grade 1/2 toxicity occurred significantly more often in the intubated group (16% vs. 0%, P = 0.03) and there was a lower incidence of grade 4 neutropenia in the nonintubated group (0% vs. 16%, P = 0.03).ConclusionsOur results showed that the nonintubated procedure resulted in improved adjuvant chemotherapy compliance and lower toxicity rates after lobectomy.Key pointsSignificant findings of the study Oncological advantage of the non‐intubated thoracic surgery: better compliance with therapy protocol. What this study adds NITS lobectomies contribute to better administration of adjuvant chemotherapy with the planned cycle number and dosage.
Highlights
Excessive surgical procedures can cause an altered, uncompensated proinflammatory response to surgical trauma and ventilation; video-assisted thoracoscopic surgery (VATS) is regarded as more reliable with a lower number of postoperative complications and morbidity.[1, 2] Unlike thoracotomy, performing Video-assisted thoracoscopic (VATS) can infer several immunological benefits associated with a favorable immune response to surgery
There was no significant differences in age, gender, body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) status and smoking habits in all patients who underwent either intubated or nonintubated VATS lobectomies
Age-adjusted Charlson Comorbidity Index (ACCI) to evaluate differences between the two groups with regard to comorbidities and weighted based on patients’ age, as it has previously been described that ACCI is a better predictor factor of survival in lung cancer patients who have undergone surgery
Summary
Excessive surgical procedures can cause an altered, uncompensated proinflammatory response to surgical trauma and ventilation; video-assisted thoracoscopic surgery (VATS) is regarded as more reliable with a lower number of postoperative complications and morbidity.[1, 2] Unlike thoracotomy, performing VATS can infer several immunological benefits associated with a favorable immune response to surgery. Nonintubated thoracic surgery (NITS) VATS procedures improves immunological responses in lung cancer patients; there is no data regarding adjuvant chemotherapy delivery effectiveness following NITS lobectomies. We aimed to compare protocol compliance and toxic complications during adjuvant chemotherapy after intubated and nonintubated VATS lobectomies in non-small cell lung cancer (NSCLC). Results: A total of 38 patients (17 males, mean age 64 years) underwent conventional VATS and 28 (7 males; mean age 63 years) uniportal VATS NITS Both groups had comparable demographic data, preoperative pulmonary function, and Eastern Cooperative Oncology Group (ECOG) status. The incidence of adenocarcinoma and squamous cell carcinoma cases were similar in both groups; the pathological staging showed significant differences, as 5 (18%) nonintubated patients had stage IB lung cancer, compared with the intubated group (P = 0.01). Conclusions: Our results showed that the nonintubated procedure resulted in improved adjuvant chemotherapy compliance and lower toxicity rates after lobectomy
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