72PD - Video-Assisted Thoracic Surgery (VATS) lobectomy for non-small cell lung cancer after induction chemotherapy: A propensity score-matched analysis o...

Abstract

Background

The aim of the present study was to assess outcomes among non-small cell lung cancer (NSCLC) patients treated with preoperative chemotherapy followed by Video-Assisted Thoracic Surgery (VATS) lobectomy from a National multi-institutional Registry.

Methods

A National Registry established in 2013 was used to collect data from 65 Thoracic Surgery Units (>3,700 patients enrolled); only information from Units with >100 VATS lobectomies enrolled were analysed. A retrospective analysis was performed on patients with NSCLC who received preoperative chemotherapy followed VATS lobectomy within one year and compared to a propensity score matched population without preoperative chemotherapy. Propensity score (greedy 5 to 1 digit matching algorithm) estimated with multiple logistic regressions based on selection bias and potential confounding variables produced 221 patients (control group). After propensity score matching, data were compared with the paired Student’s t-test, Pearson’s χ² and Fisher’s exact test. Differences were considered to be statistically significant when the p - value was <0.05.

Results

56/1679 (3.34%) patients met study inclusion criteria. There were no significant differences in baseline characteristics between groups (Table 1a). The majority of patients were clinical stage IIIA, although a small percentage of clinical stage II patients had preoperative therapy. Anatomic distribution of lobectomies and the number of resected lymph nodes not significantly differed between groups. Table 1b presents postoperative histology in the neoadjuvant groups. Table 1c reports short-term perioperative outcomes. No perioperative mortality was recorded in both groups. Overall morbidity (pneumonia, atrial fibrillation) was significantly higher in the neoadjuvant group, but interestingly, all the other variables were not influenced (conversion rate, operative time, blood loss, air leak duration, length of stay).rnTable: 72PD

Demographics, postoperative histology/stage of the neoadjuvant group, and selected perioperative/postoperative outcomes. NA = not applicable, SD = standard deviation

rnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrn

Table 1a. Demographics characteristics
Characteristics	Neoadjuvant Group (N = 56)	Propensity Matched Group (N = 221)	p - value
M/F (%)	50	61.99	0.938
Age (mean ± SD)	64.14 ± 10.64	67.44 ± 11.93	0.888
Charlson Index (mean ± SD)	4.19 ± 1.75	4.43 ± 1.85	0.530
ECOG score	0	0	NA
Preoperative stage (N, %) • IIA • IIB • IIIA	13 (23.21) 18 (32.14) 25 (44.64)	64 (28.96) 59 (26.70) 98 (44.34)	0.877 0.568 0.964
Surgical procedure (N, %) • Left upper lobectomy • Left lower lobectomy • Right upper lobectomy • Right lower lobectomy • Lower bilobectomy	8 (14.29) 10 (17.86) 25 (44.64) 12 (21.43) 1 (1.79)	43 (19.46) 29 (13.12) 89 (40.27) 36 (16.29) 3 (1.36)	0.808 0.124 0.628 0.663 0.882

rnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrn

Table 1b. Postoperative histology and stage of the Neoadjuvant Group (N, %)
Postoperative histology • Adenocarcinoma • Squamous cell carcinoma • Other	25 (44.64) 12 (21.43) 21 (37.5)
Stage • IA • IB • IIA • IIB • IIIA	7 (12.5) 12 (21.43) 22 (39.29) 1 (1.79) 14 (25)

rnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrnrn

Table 1c. Selected perioperative and postoperative outcomes
Characteristics	Neoadjuvant Group (n = 56)	Propensity Matched Group (n = 221)	p - value
Duration of surgical operation, minutes (mean ± SD)	182.14 ± 65.69	182.76 ± 66.17	0.933
Intraoperative blood loss, mL (mean ± SD)	148.93 ± 153.57	154.19 ± 126.09	0.163
Resected lymph nodes (mean ± SD)	17.54 ± 10.37	14.04 ± 7.65	0.890
Overall conversion to thoracotomy (N, %) • Lymph nodes on pulmonary artery • Anomalies of anatomy • Bleeding	6 (10.71) 3 (5.36) 1 (1.79) 2 (3.57)	20 (9.05) 11 (4.98) 1 (0.45) 8 (3.62)	0.0634 0.193 0.517 0.195
Postoperative air leaks (N, %)	6 (10.71)	12 (5.43)	0.0396
Postoperative complications (N, %) • Pneumonia • Atrial fibrillation	6 (10.71) 4 (7.14)	7 (3.17) 10 (4.52)	0.0398 0.0419
Hospital length of stay, days (mean ± SD)	8.73 ± 6.60	9.54 ± 8.92	0.759

rn

Conclusions

VATS lobectomy after induction chemotherapy in stage II/IIIA NSCLC is feasible with a favourable profile regarding overall morbidity and mortality. This preliminary report shows that neoadjuvant treatment may not represent per se a contraindication to the VATS approach.

Clinical trial identification

Legal entity responsible for the study

Italian VATS Group

Funding

Italian VATS Group

Disclosure

All authors have declared no conflicts of interest.