According to an article recently published in the Annals of Thoracic Surgery, a less invasive surgical approach allows more patients with non-small cell lung cancer to undergo optimal scheduling and dosing of chemotherapy.

Lung cancer remains the leading cause of cancer-related deaths in the world. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer in the United States, accounting for approximately 75-80% of all lung cancers, and refers to the type of cell within the lung that the cancer originated.

Early NSCLC refers to cancer that has not spread to distant sites in the body. Standard treatment for early NSCLC includes the surgical removal of the cancer, followed by chemotherapy and/or radiation therapy. The delivery of full doses of chemotherapy and/or radiation therapy on a prescribed schedule is important to achieve optimal outcomes for these patients. Therefore, recent research has focused on identifying variables that may prevent or reduce the delivery of full doses and/or may prevent or delay the administration of doses of therapy.

Historically, a thoracotomy was performed to surgically remove a lobe of the lung (lobectomy) that contained the cancer. However, a thoracotomy is a major and very invasive surgical procedure that includes the breaking and spreading of ribs and cutting through large amounts of tissue and muscle to gain access to the lung. More recently, less invasive surgical procedures have emerged, including thoracoscopic lobectomies. This procedure involves small incisions through which the body cavity can be visualized and surgeons can perform procedures with the aid of a video camera. Ultimately, less invasive procedures allow for faster healing time and the potential to better tolerate additional therapy.

Researchers from Duke University recently reviewed outcomes of 100 patients with early NSCLC who underwent either a thoracotomy (43 patients) or a thoracoscopic lobectomy (57 patients). All patients went on to receive chemotherapy, and 20% of patients received radiation therapy.

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• Delayed chemotherapy doses occurred in only 18% of patients who underwent a thoracoscopic lobectomy, compared with 58% of patients who underwent a thoracotomy.

• Reduced chemotherapy doses occurred in 26% of patients who underwent a thoracoscopic lobectomy, compared with 49% of patients who underwent a thoracotomy.

• Patients who underwent a thoracoscopic lobectomy had a medical hospital stay of 4 days; those who underwent a thoracotomy had a median hospital stay of 5 days.

The researchers concluded that “Thoracoscopy was associated with an overall higher compliance rate and fewer delayed or reduced doses of chemotherapy in patients receiving adjuvant chemotherapy.” Patients diagnosed with NSCLC who are to undergo a lobectomy should speak with their physician regarding their individual risks and benefits of specific surgical procedures.

Reference: Petersen R, DuhKhanh P, Burfeind W, et al. Thoracoscopic Lobectomy Facilitates the Delivery of Chemotherapy after Resection for Lung Cancer. Annals of Thoracic Surgery. 2007; 83:1245-1250.

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