SESSION TYPE: Thoracic Surgery Posters II
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Data on stage-specific outcomes following video-assisted thoracoscopic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC) is underreported. This study evaluated the midterm results of patients who underwent VATS lobectomy for resection of primary NSCLC and identified outcomes by stage groups.
METHODS: From January 2006 to December 2011, 174 patients (mean 66 years, range 32 to 95) with NSCLC underwent VATS lobectomy (pathologic Stage I 69%(120), Stage II 14%(25), Stage III 14%(24) and Stage IV 3%(5); p<0.001). Patients were identified from a retrospective review of a prospectively-maintained database. Multivariable analysis was used to identify predictors of postoperative recurrence and poor survival.
RESULTS: Thirty-day mortality was 0%. Postoperative chemotherapy and or radiotherapy treatment were not routinely administered in patients with stage I disease (6%(7), but administration increased with stage: 48%(12), 33%(8) and 80%(4) for stages II to IV, respectively (p<0.001). Recurrence-free survival was stage-dependent: 88%,68%,68%,and 56% at 1 year, and 78%,48%,46%, and 56% at 2 years for stages I to IV, respectively (p<0.01). However, overall survivals were similar (95%, 95%, 95%, and 100% at 1 year; 91%, 77%%, 69%, and 75% at 2 years; 82%,77%,69%, and 75% at 3 years for stages I to IV, respectively (p=0.28). Recurrence was more common in stages I and III patients with higher Charlson Comorbidity Index scores (CCI) (p< 0.001 and p< 0.05, respectively). Stage II patients with inferior American Society of Anesthesiologist scores (p<0.05) and larger tumors (mean 2.9 cm) (p<0.05) had higher recurrence rates. In stage I and III patients, survival was negatively associated with higher CCI (p< 0.001 and p< 0.05, respectively), development of recurrence (p< 0.001 and p< 0.05, respectively), and with worse Zubrod scores in stage III patients (p<0.05) only.
CONCLUSIONS: VATS lobectomy for primary lung cancer results in excellent midterm outcomes. Recurrence-free survival was stage-dependent, with the recurrence risk within stages impacted by patient-related factors and tumor size; however, equivalent overall 3-year survival was observed for all stage groups.
CLINICAL IMPLICATIONS: This study suggests patient characteristics, tumor size and stage all influence the recurrence after VATS lobectomy in patients with NSCLC.
DISCLOSURE: The following authors have nothing to disclose: Virna Sales, Ann Traynor, Tien Hoang, Toby Campbell, George Cannon, Tracey Weigel
No Product/Research Disclosure InformationDepartment of Surgery, Section of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Wisconsin Carbone Cancer Center, UW-Madison School of Medicine Public Health, Madison, WI