Abstract | November 12, 2020

Thoracoscopic Lobectomy after Neoadjuvant Chemoradiation

Presenting Author: Sahil Dayal, BS Biology, BA Chemistry, Brody School of Medicine, MS3, Division of Thoracic Surgery, Brody School of Medicine, Greenville, NC

Learning Objectives

  1. Standard of care for NSCLC.
  2. Options for treatment of NSCLC.

Background: Non-small cell lung cancer remains the most common cause of neoplastic mortality in the United States. Surgical resection of early stage non-small cell lung cancer (NSCLC) is recommended as first line intervention, however later stage, advanced local-regional cancers (Stage IIIa) often are treated with neoadjuvant chemotherapy and radiation therapy prior to consideration of surgical resection. Preoperative radiation, and to a lesser extent chemotherapy, increases the complexity of surgical resection due to development of dense inflammatory tissue, edema, and scarring adhesions. The increased difficulty in post chemoradiation therapy (CRT) patients has resulted in slow adoption of minimally invasive techniques for post-neoadjuvant resection.

In the past, surgical resection for NSCLC has been proven to be efficacious after CRT, but the available data focuses mostly on open-chest procedures. The aim of our study was to demonstrate that there was no difference in surgical outcomes when performing minimally invasive thoracoscopic lobectomy after neoadjuvant chemoradiotherapy.

Methods: An IRB-approved, retrospective analysis of an institutional RedCap database was conducted of 275 patients who underwent lobectomy between the years 2014 and 2019 at a single institution. Baseline variables, demographics, surgical procedure data, pathologic findings, and postoperative outcomes were collected. Statistical analysis of continuous and categorical data was conducted to compare outcomes of patients undergoing thoracoscopic lobectomy with history of neoadjuvant CRT, chemotherapy only, and radiation only to those with no CRT. Statistics were performed using a standard ANOVA for the continuous data and Fischer’s Exact chi square test for the categorical data in SPSS.

Results: There were no differences between the neoadjuvant CRT, chemotherapy only, and radiation only groups versus no CRT groups with respect to age, gender, BMI, presence of pulmonary disease, presence of cardiovascular disease, preoperative FEV1, estimated blood loss, length of hospital stay, ICU stay, days on ventilator, chest tube duration, presence of air leak, presence of post-op general complications, nor 30 day and 60 day mortalities. There were significant differences between the groups for the demographic categories of preoperative DCLO, smoking history, and current smoking status, and also in postoperative outcomes in the presence of lower rates of post-op pulmonary complications in the radiation only group. See Table 1.

Conclusions: There were no significant differences found in surgical outcomes for thoracoscopic lobectomy after neoadjuvant therapies when compared to patients who went directly to surgery. The exception was a lower rate of pulmonary complications seen in radiation only patients, which may be attributable to selection bias, sample size, or the lower rate of current smokers in the radiation only group. In any case, the data indicates that thoracoscopic lobectomy after neoadjuvant chemo/radiation is a safe option for patients with advanced regional non-small cell lung cancer.

Table 1

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