Thoracoscopic Lobectomy Is Associated With Superior Compliance With Adjuvant Chemotherapy in Lung Cancer

Background. Although the survival benefit of adjuvant chemotherapy for nonsmall-cell lung cancer has been proved, 50% to 86% of patients received all planned cycles of chemotherapy. A thoracoscopic procedure may enable more effective administration of adjuvant chemotherapy than a thoracotomy. However, a well-balanced comparison is lacking. Methods. Patients who underwent pulmonary resection and received platinum-based double adjuvant chemotherapy for nonsmall-cell lung cancer were identified from a prospective database. A propensity score-matched analysis was performed to obtain a well-balanced comparison between thoracoscopy and thoracotomy to determine compliance of adjuvant chemotherapy. Results. Seventy-four patients (group A) with thoracoscopy and 278 patients with thoracotomy received adjuvant chemotherapy. Through 1: 1 matching, 74 patients (group B) were selected from the thoracotomy group. A higher percentage of group A received four cycles of the planned adjuvant chemotherapy (95.9% versus 82.4%, p = 0.015). There was a trend toward better compliance in group A with four cycles of adjuvant chemotherapy without reduced dose (83.8% versus 73.0%, p = 0.162), and four cycles of adjuvant chemotherapy without delayed or reduced dose (70.3% versus 62.2%, p = 0.385). Conclusions. Thoracoscopy showed better compliance with adjuvant chemotherapy after pulmonary resection for nonsmall-cell lung cancer. (Ann Thorac Surg 2011; 91: 344-9) (C) 2011 by The Society of Thoracic Surgeons