Abstract
BackgroundSurgery is an important part of multidisciplinary treatment strategy for locally advanced lung squamous cell carcinoma (LSCC), but insufficient evidence supports the feasibility and safety of video assisted thoracic surgery (VATS) following neoadjuvant chemotherapy for locally advanced LSCC. This study aims to compare perioperative data and long-term survival of locally advanced LSCC patients between VATS and thoracotomy after neoadjuvant chemotherapy.MethodsWe retrospectively collected the clinical and pathological information of patients with locally advanced LSCC who underwent surgical resection after neoadjuvant chemotherapy from October 2013 to October 2017. All patients were divided into two groups (thoracotomy and VATS) and were compared the differences in perioperative, oncological and survival outcomes.ResultsA total of 81 patients were analyzed in this study (67 thoracotomy and 14 VATS). VATS provided less postoperative pain (P = 0.005) and produced less volume of chest drainage (P = 0.019) than thoracotomy, but the number of resected lymph nodes was less in VATS group (P = 0.011). However, there was no significant difference in the number of resected lymph node stations and the rate of nodal upstaging between two groups. The mean disease free survival (DFS) was 32.7 ± 2.7 months for the thoracotomy group and 31.8 ± 3.0 months for the VATS group (P = 0.335); the corresponding overall survival (OS) was 41.7 ± 2.2 months and 36.4 ± 4.1 months (P = 0.925).ConclusionIn selected patients with locally advanced LSCC, VATS played a positive role in postoperative recovery and associated similar survival outcome compared with thoracotomy after neoadjuvant chemotherapy.
Highlights
Lung cancer is one of the most common cancers and the leading cause of cancer-related death in the world, and more than 80% of patients have a group of histological subtypes known as non-small cell lung cancer (NSCLC) [1]
There were only few studies reporting the outcome of video assisted thoracic surgery (VATS) following neoadjuvant therapy [12, 13] and currently, no published study reported the comparison between VATS and thoracotomy following neoadjuvant chemotherapy in locally advanced lung squamous cell carcinoma (LSCC) staged by the eighth American Joint Committee on Cancer (AJCC 8) staging system
All patients included in the analysis were restaged by AJCC 8 staging system [14] and fitted the following criteria: (1) the disease was pathologically diagnosed as LSCC; (2) the patient did not have distant metastasis before neoadjuvant chemotherapy; (3) the surgery was preceded by neoadjuvant chemotherapy
Summary
Lung cancer is one of the most common cancers and the leading cause of cancer-related death in the world, and more than 80% of patients have a group of histological subtypes known as non-small cell lung cancer (NSCLC) [1]. Fang et al Journal of Cardiothoracic Surgery (2018) 13:128 the operation based multidisciplinary treatment, one of which is the selection of surgical approaches after neoadjuvant chemotherapy, thoracotomy or video assisted thoracic surgery (VATS). VATS was initially proposed only for operable early stage lung cancer, but in recent years it has been carried out by some experienced thoracic surgeons in LANSCLC with satisfactory outcome [10, 11]. Surgery is an important part of multidisciplinary treatment strategy for locally advanced lung squamous cell carcinoma (LSCC), but insufficient evidence supports the feasibility and safety of video assisted thoracic surgery (VATS) following neoadjuvant chemotherapy for locally advanced LSCC. This study aims to compare perioperative data and long-term survival of locally advanced LSCC patients between VATS and thoracotomy after neoadjuvant chemotherapy
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