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D. Divisi



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    Imaging and locally advanced NSCLC (ID 41)

    • Event: ELCC 2017
    • Type: Poster Discussion session
    • Track:
    • Presentations: 1
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      72PD - Video-Assisted Thoracic Surgery (VATS) lobectomy for non-small cell lung cancer after induction chemotherapy: A propensity score-matched analysis on behalf of the Italian VATS group (ID 255)

      14:45 - 15:45  |  Author(s): D. Divisi

      • 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 χ[2] 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: 72PDDemographics, postoperative histology/stage of the neoadjuvant group, and selected perioperative/postoperative outcomes. NA = not applicable, SD = standard deviationrn

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      Table 1a. Demographics characteristics
      CharacteristicsNeoadjuvant Group (N = 56)Propensity Matched Group (N = 221)p - value
      M/F (%)5061.990.938
      Age (mean ± SD)64.14 ± 10.6467.44 ± 11.930.888
      Charlson Index (mean ± SD)4.19 ± 1.754.43 ± 1.850.530
      ECOG score00NA
      Preoperative stage (N, %) • IIA • IIB • IIIA13 (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 bilobectomy8 (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
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      Table 1b. Postoperative histology and stage of the Neoadjuvant Group (N, %)
      Postoperative histology • Adenocarcinoma • Squamous cell carcinoma • Other25 (44.64) 12 (21.43) 21 (37.5)
      Stage • IA • IB • IIA • IIB • IIIA7 (12.5) 12 (21.43) 22 (39.29) 1 (1.79) 14 (25)
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      Table 1c. Selected perioperative and postoperative outcomes
      CharacteristicsNeoadjuvant Group (n = 56)Propensity Matched Group (n = 221)p - value
      Duration of surgical operation, minutes (mean ± SD)182.14 ± 65.69182.76 ± 66.170.933
      Intraoperative blood loss, mL (mean ± SD)148.93 ± 153.57154.19 ± 126.090.163
      Resected lymph nodes (mean ± SD)17.54 ± 10.3714.04 ± 7.650.890
      Overall conversion to thoracotomy (N, %) • Lymph nodes on pulmonary artery • Anomalies of anatomy • Bleeding6 (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 fibrillation6 (10.71) 4 (7.14)7 (3.17) 10 (4.52)0.0398 0.0419
      Hospital length of stay, days (mean ± SD)8.73 ± 6.609.54 ± 8.920.759
      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.