Uniportal video-assisted thoracoscopic surgery following neoadjuvant chemotherapy for locally-advanced lung cancer

Abstract

BackgroundSeveral retrospective studies have confirmed that video-assisted thoracoscopic surgery (VATS) following neoadjuvant chemotherapy is a safe and feasible treatment for advanced non-small cell lung cancer patients. As a minimally invasive technique, VATS usually leads to better clinical outcomes and better compliance with adjuvant treatment than conventional thoracotomy. Uniportal VATS (U-VATS) as an alternative option to conventional multi-port VATS has attracted much attention recently because reduced number and size of incisions may help to decrease inflammatory response and reduce postoperative pain for patients. However, rarely studies have reported the application of U-VATS following neoadjuvant chemotherapy for the treatment of advanced lung cancer patients.MethodsA total of 29 lung cancer patients undergoing VATS following neoadjuvant chemotherapy were included in this study. The clinical data of these patients were retrospectively analyzed, including the preoperative neoadjuvant chemotherapy plan, surgical effect, postoperative complications, operation time, operative blood loss, number of lymph nodes dissected and postoperative mortality.ResultsAll patients underwent VATS following two cycles of neoadjuvant chemotherapy. Among these patients, 26 completed U-VATS, two were converted to triple-port VATS, and one was converted to open thoracotomy. The operation time ranged from 120 min to 300 min (mean: 160 ± 38.5 min); the operative blood loss was 50–500 ml (mean:167.8 ± 78.4 ml); the number of lymph nodes dissected was 16–28 (mean: 21.9 ± 3.7); the postoperative drainage time was 3–13 d (mean: 5.6 ± 1.9 d); and the postoperative hospital stay was 6–16 d (7.7 ± 1.9 d). Postoperative complications occurred in five (17.2%) patients, including three cases of respiratory infection, one case of air leakage (more than two weeks), and one case of wound infection. In addition, the 30- and 90-day postoperative mortality was zero.ConclusionU-VATS following neoadjuvant chemotherapy is feasible and safe for the treatment of advanced lung cancer patients.

Cirugía Torácica Videoasistida Uniportal en Dos Centros Universitarios. Experiencia Inicial

“…Al igual que lo sucedido con la VATS en relación con las técnicas abiertas, toda nueva técnica debe demostrar tener iguales o mejores resultados que el estándar de tratamiento 24 . La VATS uniportal representa uno de los últimos avances técnicos en cirugía torácica, es producto de modificaciones progresivas de las técnicas de VATS clásica, y ha demostrado rápidamente tener resultados absolutamente comparables a la VATS convencional 20,25,26 .…”

Heterogeneity of stage IIIA non-small cell lung cancer—different tumours, different nodal status, different treatment, different prognosis: a narrative review

“…There is minimal risk of additional surgical complications following neoadjuvant chemoradiotherapy (49,146,(169)(170)(171)(172)(173).…”

“…Anatomical resections performed by VATS are an appropriate therapeutic approach in operable patients with resectable tumours, even in locally advanced stage IIIA, as far as there are no compromises of oncological principles and complete R0 en-bloc resection is feasible (7,229,245,246,250). VATS has also been shown to be a safe and feasible approach following neoadjuvant chemotherapy in these locally advanced tumours, even in limited sulcus superior tumours (170,171,251,252).…”

“…Preoperative chemotherapy as well as radiotherapy can induce local tissue inflammation and edema, resulting in tissue adhesions with partially fused interlobar fissure, hilar and mediastinal fibrosis with anthracofibrosis and perivascular/peribronchial lymph node calcification as well as increased tissue and especially vascular fragility. Thus, making surgery in general more difficult and adhesiolysis and anatomic dissection more tedious with potentially higher operation time (35,170,171,253).…”

“…Since safety has always been of highest importance for surgeons, this implies that thoracic surgeons may favor adjuvant therapy, avoiding possible tedious dissection. On the contrary, other authors confirmed the safety and feasibility of VATS following neoadjuvant treatment without an increase of postoperative complications (170)(171)(172)(173). Therefore, it is important to highlight the uniportal VATS approach, resulting in a direct view, the same way as provided due to open thoracotomy (172,173), with an easier access for dense adhesions after neoadjuvant treatment in locally advanced NSCLC.…”