Journal
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
Volume 36, Issue 2, Pages 1466-1475Publisher
SPRINGER
DOI: 10.1007/s00464-021-08431-z
Keywords
VATS; Non-small-cell lung cancer; Neoadjuvant chemotherapy; Lobectomy; Minimally invasive thoracic surgery
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Funding
- Universita degli Studi di Padova within the CRUI-CARE Agreement
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Video-assisted thoracoscopic surgery (VATS) lobectomy appears to be a valid therapeutic option for patients with non-small-cell lung cancer after neoadjuvant chemotherapy, showing superior perioperative outcomes compared to open surgery while maintaining oncological efficacy on long-term follow-up.
Background The role of video-assisted thoracoscopic surgery for the treatment of non-small-cell lung cancer after neoadjuvant chemotherapy remains controversial. The aim of this study is to demonstrate the reliability of video-assisted lobectomy compared to the open approach by evaluating perioperative and long-term outcomes. Methods In this retrospective, multicentric study from January 2010 to December 2018, we included all patients with non-small-cell lung cancer who underwent lobectomy through the video-assisted or open approach after neoadjuvant chemotherapy. The perioperative outcomes, including data concerning the feasibility of the surgical procedure, the occurrence of any medical and surgical complications and long-term oncological evidence, were collected and compared between the two groups. To minimize selection bias, propensity score matching was performed. Results A total of 286 patients were enrolled: 193 underwent thoracotomy lobectomy, and 93 underwent VATS lobectomy. The statistical analysis showed that surgical time (P < 0.001), drainage time (P < 0.001), days of hospitalization (P < 0.001) and VAS at discharge (P = 0.042) were lower in the VATS group. The overall survival and disease-free survival were equivalent for the two techniques on long-term follow-up. Conclusions VATS lobectomy represents a valid therapeutic option in patients affected by non-small-cell lung cancer after neoadjuvant chemotherapy. The VATS approach in our experience seems to be superior in terms of the perioperative outcomes, while maintaining oncological efficacy.
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