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R.I. Whyte



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    ORAL 36 - Translational Science/Radiation (ID 151)

    • Event: WCLC 2015
    • Type: Oral Session
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      ORAL36.05 - Results of a National Database Review of Video-Assisted Thoracoscopic versus Open Lobectomy after Induction Therapy (ID 1533)

      17:28 - 17:39  |  Author(s): R.I. Whyte

      • Abstract
      • Presentation
      • Slides

      Background:
      Minimally invasive lobectomy has become the standard of care approach for early stage non-small cell lung cancer (NSCLC); however video assisted thoracoscopic (VATS) lobectomy after induction therapy remains controversial. We sought to evaluate perioperative outcomes of VATS and open lobectomy after induction therapy using a national database.

      Methods:
      A cohort study of patients that underwent VATS and open lobectomy after induction chemotherapy and/or radiotherapy was conducted using the National Surgical Quality Improvement Program (NSQIP) database from 2005 through 2012. Perioperative complications and mortality were compared between groups. Comparisons were made using two-sided student’s t-test or chi square test as appropriate.

      Results:
      A total of 6730 patients underwent lobectomy during the study period and 166 patients had prior induction therapy (open = 132, VATS = 34). There were no statistically significant differences in age, comorbidities or ASA class between groups. There were no significant differences in the surgeon specialty between groups (cardiac, thoracic, general, and vascular). Operative time was similar (VATS: 228 minutes, Open: 190 minutes; p = 0.07). Perioperative complications, return to OR, respiratory complication, mortality, and hospital length of stay were similar between groups. Table 1. Patient Demographics

      N (%) All (N = 166) Open (N = 132) VATS (N = 34) P-value
      Age, yrs; Mean (SD) 62.9 (10.2) 62.4 (10.7) 65.2 (7.6) 0.077
      Female 88 (53) 72 (55) 16 (49) 0.563
      Diabetes 16 (10) 11 (8) 5 (15) 0.325
      COPD 35 (21) 26 (20) 9 (27) 0.479
      Creatinine > 1.2 17 (10) 13 (10) 4 (12) 0.757
      ASA Class ≥4 18 (11) 14 (11) 4 (12)
      VATS = video assisted thoracoscopic, COPD = chronic obstructive pulmonary disease, ASA= American Society of Anesthesia class Table 2. Post-Operative Outcomes
      N (%) All (N = 166) Open (N = 132) VATS (N = 34) P-value
      LOS, days; mean (SD) 7.3 (6.1) 7.4 (6.1) 6.6 (6.3) 0.471
      Wound complication 5 (3) 5 (4) 0 0.584
      Pneumonia 16 (10) 15 (11) 1 (3) 0.197
      Reintubation 18 (11) 15 (11) 3 (9) 1.000
      Respiratory complication 25 (15) 22 (17) 3 (9) 0.419
      Return to OR 15 (9) 14 (11) 1 (3) 0.311
      In hospital mortality 9 (5) 8 (6) 1 (3) 0.687
      30 day mortality 13 (8) 12 (9) 1 (3) 0.471
      VATS= video assisted thoracoscopic, LOS = length of stay, OR= operating room

      Conclusion:
      This is the first review of a prospective national database comparing outcomes for VATS and open lobectomy after induction therapy for NSCLC. VATS lobectomy appears to be safe with no increased morbidity or mortality compared to open in patients that had prior induction therapy. A larger series of matched VATS and open approaches after induction therapy is needed.

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