Neoadjuvan tedavi sonrası videotorakoskopik anatomik akciğer rezeksiyonu uygulanan küçük hücreli dışı akciğer kanserli hastaların retrospektif analizi
Date
2024
Authors
Sevinç, Tolga Evrim
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Amaç: Küçük hücreli dışı akciğer kanserinin (KHDAK) cerrahi tedavisinde neoadjuvan tedavi (NT) varlığı videotorakoskopik (VATS) anatomik akciğer rezeksiyonu için göreceli bir kontrendikasyon olarak kabul edilmektedir. Ancak NT, tümör evresinde ve çapında küçülme yapması durumunda VATS sıklığını arttırabilir. Literatürde çok az sayıda çalışma NT sonrası VATS'ın sonuçlarını analiz etmiştir. Bu çalışmanın amacı NT alan KHDAK hastalarında VATS'ın uygulanabilirliğini, güvenliğini ve sonuçlarını değerlendirmektir. Gereç-Yöntemler: Ocak 2011 ile Aralık 2021 tarihleri arasında kliniğimizde KHDAK tanısıyla VATS anatomik akciğer rezeksiyonu (segmentektomi ve büyük rezeksiyonlar) ve lenf nodu diseksiyonu uygulanan hastaların verileri prospektif olarak kaydedilip, retrospektif olarak analiz edildi. Hastalar 2 gruba ayrıldı. Grup 1: Ameliyat öncesi onkolojik tedavi almayan hastalar (G1, VATS), Grup 2: Ameliyat öncesi NT alan hastalar (G2, VATS neo). Grupların demografik özellikleri, tedavi rejimleri, cerrahi detayları, morbidite/mortalite ve patolojik evreleri karşılaştırıldı. Bulgular: Çalışmaya 65 kadın 240 erkek, ortalama yaş 65 (26-83) olan toplam 305 hasta (G1 n=236, G2 n=69) dahil edildi. G2'de hastaların 22'sinde (%31,9) NT öncesi tümör çapı 5 cm'den büyüktü. Elli beş hastaya kemoterapi, altısına kemoradyoterapi, birine kemoradyoterapi ve immünoterapi, yedisine ise kemoterapi ve immünoterapi uygulandı. Torakotomiye geçiş G1'de n=42 (%17,8), G2'de n=18 (%26,1), p=0,128 idi. Postoperatif 100 hastada (%32,8) komplikasyon geliştiği görüldü (G1'de n= 75 (%31,9), G2'de n=25 (%36,2), p=0,5). Mortalite oranı G1'de n=5 (%2,1), G2'de n=1 (%1,4), p=1,0 idi. Uzak metastaz/lokal nüks G1'de n=49 (%21,2), G2'de n=20 (%29,4), p=0,16, idi. Beş yıllık sağkalım G1de %74,4, G2’de %68,1, p=0,134 olarak izlendi. Sonuç: Çalışmamız benzer onkolojik sonuçlarla NT uygulanan hastalarda VATS ile akciğer rezeksiyonunun güvenli bir şekilde yapılabileceğini ve ayrıca VATS sıklığını artırabileceğini de göstermektedir.
Aim: The presence of neoadjuvant therapy (NT) in the surgical treatment of non-small cell lung cancer (NSCLC) is considered a relative contraindication for videothoracoscopic (VATS) anatomical lung resection. However, NT may increase the frequency of VATS if it reduces the tumor stage and diameter. Very few studies in the literature have analyzed the outcomes of VATS after NT. The aim of this study was to evaluate the feasibility, safety, and outcomes of VATS in NSCLC patients receiving NT. Methods: Data of patients who underwent VATS anatomical lung resection (segmentectomy and large resections) and lymph node dissection with the diagnosis of NSCLC in our clinic between January 2011 and December 2021 were recorded prospectively and analyzed retrospectively. The patients were divided into 2 groups. Group 1: Patients who did not receive oncological treatment before surgery (G1, VATS), Group 2: Patients who received NT before surgery (G2, VATS neo). Demographic characteristics, treatment regimens, surgical details, morbidity/mortality and pathological stages of the groups were compared. Results: A total of 305 patients (G1 n=236, G2 n=69), 65 women and 240 men, with an average age of 65 (26-83) were included in the study. In G2, the tumor diameter before NT was larger than 5 cm in 22 (31.9%) of the patients. Fifty-five patients received chemotherapy, six received chemoradiotherapy, one received chemoradiotherapy and immunotherapy, and seven received chemotherapy and immunotherapy. Conversion to thoracotomy was n=42 (17.8%) in G1, n=18 (26.1%) in G2, p=0.128. Postoperative complications were observed in 100 patients (32.8%) (n= 75 (31.9%) in G1, n=25 (36.2%) in G2, p=0.5). Mortality rate was n=5 (2.1%) in G1, n=1 (1.4%) in G2, p=1.0. Distant metastasis/local recurrence was n=49 (21.2%) in G1, n=20 (29.4%) in G2, p=0.16. Five-year survival was observed as 74.4% in G1 and 68.1% in G2, p = 0.134. Conclusion: Our study shows that lung resection with VATS can be performed safely in patients who underwent NT with similar oncological results and may also increase the frequency of VATS.
Aim: The presence of neoadjuvant therapy (NT) in the surgical treatment of non-small cell lung cancer (NSCLC) is considered a relative contraindication for videothoracoscopic (VATS) anatomical lung resection. However, NT may increase the frequency of VATS if it reduces the tumor stage and diameter. Very few studies in the literature have analyzed the outcomes of VATS after NT. The aim of this study was to evaluate the feasibility, safety, and outcomes of VATS in NSCLC patients receiving NT. Methods: Data of patients who underwent VATS anatomical lung resection (segmentectomy and large resections) and lymph node dissection with the diagnosis of NSCLC in our clinic between January 2011 and December 2021 were recorded prospectively and analyzed retrospectively. The patients were divided into 2 groups. Group 1: Patients who did not receive oncological treatment before surgery (G1, VATS), Group 2: Patients who received NT before surgery (G2, VATS neo). Demographic characteristics, treatment regimens, surgical details, morbidity/mortality and pathological stages of the groups were compared. Results: A total of 305 patients (G1 n=236, G2 n=69), 65 women and 240 men, with an average age of 65 (26-83) were included in the study. In G2, the tumor diameter before NT was larger than 5 cm in 22 (31.9%) of the patients. Fifty-five patients received chemotherapy, six received chemoradiotherapy, one received chemoradiotherapy and immunotherapy, and seven received chemotherapy and immunotherapy. Conversion to thoracotomy was n=42 (17.8%) in G1, n=18 (26.1%) in G2, p=0.128. Postoperative complications were observed in 100 patients (32.8%) (n= 75 (31.9%) in G1, n=25 (36.2%) in G2, p=0.5). Mortality rate was n=5 (2.1%) in G1, n=1 (1.4%) in G2, p=1.0. Distant metastasis/local recurrence was n=49 (21.2%) in G1, n=20 (29.4%) in G2, p=0.16. Five-year survival was observed as 74.4% in G1 and 68.1% in G2, p = 0.134. Conclusion: Our study shows that lung resection with VATS can be performed safely in patients who underwent NT with similar oncological results and may also increase the frequency of VATS.
Description
Keywords
Neoadjuvan, Videotorakoskopi, Akciğer rezeksiyon, Videothoracoscopy, Lung resection, Neoadjuvant