Jing Xiaogang, Lin Ying, Zhang Beifeng, Zhang Guojun
Department of Respiration, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
J BUON. 2016 Nov-Dec;21(6):1524-1529.
Delaying adjuvant chemotherapy initiation >8 weeks after radical lobectomy for non-small cell lung cancer (NSCLC) adversely affects overall survival. The effect of video-assisted thoracoscopic lobectomy (VATS) on adjuvant chemotherapy initiation is yet unclear. This study aimed to determine if using VATS for NSCLC resection affected the timing of adjuvant chemotherapy and oncological outcomes.
Patients who underwent radical lobectomy for pathological stage II or IIIA NSCLC and received adjuvant chemotherapy between January 2009 and January 2016 were identified from a prospectively maintained lung cancer database. Patients were categorized according to surgical approach: open lobectomy or VATS. Patient demographics, clinicopathological data, postoperative complications, time from radical lobectomy to adjuvant chemotherapy initiation, and long-term survival outcomes were compared.
Age, gender, American Society of Anesthesiologists (ASA) class, comorbidity, TNM stage, and postoperative complications were similar between VATS and open cases; however, length of stay was shorter in VATS cases. No difference was observed in the proportion of patients who received adjuvant chemotherapy >8 weeks after radical lobectomy between the two groups. In the open group, a delay in adjuvant chemotherapy after radical lobectomy was associated with decreased overall survival (OS) and disease-free survival (DFS). However, delay in chemotherapy did not affect OS or DFS in the VATS group.
The benefits of quicker recovery after VATS did not result in earlier adjuvant chemotherapy initiation in this retrospective study. However, VATS negated the inferior oncologic outcomes associated with delayed adjuvant chemotherapy initiation.
非小细胞肺癌（NSCLC）根治性肺叶切除术后辅助化疗开始时间推迟超过8周会对总生存期产生不利影响。电视辅助胸腔镜肺叶切除术（VATS）对辅助化疗开始时间的影响尚不清楚。本研究旨在确定采用VATS进行NSCLC切除是否会影响辅助化疗的时机和肿瘤学结局。
从一个前瞻性维护的肺癌数据库中识别出2009年1月至2016年1月期间接受II期或IIIA期NSCLC根治性肺叶切除术并接受辅助化疗的患者。根据手术方式将患者分类：开放性肺叶切除术或VATS。比较患者的人口统计学、临床病理数据、术后并发症、从根治性肺叶切除术到辅助化疗开始的时间以及长期生存结局。
VATS组和开放手术组在年龄、性别、美国麻醉医师协会（ASA）分级、合并症、TNM分期和术后并发症方面相似；然而，VATS组的住院时间较短。两组之间在根治性肺叶切除术后超过8周接受辅助化疗的患者比例上未观察到差异。在开放手术组中，根治性肺叶切除术后辅助化疗延迟与总生存期（OS）和无病生存期（DFS）降低相关。然而，化疗延迟在VATS组中并未影响OS或DFS。
在这项回顾性研究中，VATS术后恢复更快的益处并未导致辅助化疗开始时间更早。然而，VATS消除了与辅助化疗开始延迟相关的较差肿瘤学结局。
