PUB010 Intraoperative Blood Loss is an Independent Predictor of Poor Disease Free Survival for Patients Undergoing VATS Lobectomy for Lung Cancer

Abstract

There are concerns regarding the independent effect of intra-operative estimated blood loss(EBL)on the oncological outcome of patients undergoing lung cancer surgery. A negative immunomodulatory effect has been hypothesized. These effects have been observed after conventional open surgery. Little is known in regards to the impact of blood loss in a VATS approach on outcome. Therefore, we sought to assess the effect of intraoperative blood loss on disease free survival for a select subset of patients undergoing VATS lobectomy for NSCLC. A prospectively collected lung cancer database was retrospectively reviewed to identify patients undergoing VATS lobectomy for NSCLC (2009-2014). Clinico-pathological characteristics and follow up data were retrieved from the database as well as the patients’ medical records. Cox regression analysis was used to identify independent predictors of disease free survival (DFS). In the study period, 551 VATS lobectomies were done (median age 72 years, 35% were males).Median Charlson comorbidity index (CCI) was 1. Median FEV1% and DLCO% were 91% and 83% respectively. The majority of patients were clinical stage 1 (459 patients, 83.3%; 3yr DFS: 85.5%). 80 % of the patients had adenocarcinoma histology, and moderately/poorly differentiated tumors represented 83%. Median OR-time and EBL were 132 minutes and 100 CC respectively. Conversion to thoracotomy was encountered in 30 patients (5.4%). 148 patients (26.9%) had post-operative complications [Clavien-Dindo (CD) >1]. Reoperation was needed in 9 patients (1.6%). 3 patients (0.5%) had 30-days postoperative mortality. Univariate predictors of poor DFS were male gender, former/current smokers, CCI>1, clinical stage III, moderate/poor differentiation, right side lobectomies and EBL ≥ 250cc.On multivariable analysis only male gender(HR: 1.79, 95%CI: 1.16-2.76), and EBL≥ 250cc (HR: 1.65, 95%CI: 1.04-2.61) independently predicted poor DFS. In patients undergoing VATS lobectomy for NSCLC, EBL was the only modifiable predictor of poor DFS. The results of this study should be cautiously interpreted and needs to be furtherly validated in larger data sets.