Impact of Robotic-Assisted Thoracic Surgery on the Completion of Adjuvant Chemotherapy Following Lung Cancer Resection

Background Adjuvant chemotherapy can further improve treatment outcomes following the resection of non-small cell lung cancer (NSCLC). However, in practice, some patients are unable to tolerate all prescribed chemotherapy. One of the factors which may implicate adjuvant chemotherapy completion is a surgical technique. We investigated the impact of robotic-assisted thoracic surgery (RATS), a form of minimally invasive surgery, on chemotherapy completion. Methods We conducted a retrospective study of NSCLC patients who underwent adjuvant platinum-based chemotherapy at our institution during 2010-2020. The primary outcome of interest was chemotherapy completion, defined as receiving all 4 cycles of chemotherapy. We also performed an exploratory analysis to identify factors associated with chemotherapy completion. Results Analyses included 165 patients: 95 patients underwent traditional thoracotomy, and 70 patients underwent RATS. Baseline characteristics were comparable except for smaller tumor size and lower stage in the RATS group. Median operative time was longer in the RATS group than in the thoracotomy group: 198 vs. 139 minutes, p<0.001. Chemotherapy completion rates were not significantly different between groups: 74.3% vs. 75.8%, p=0.83, respectively. In addition, no significant difference was found in the incidences of postoperative complications between groups. In a propensity score matched analysis, there was also no difference in the chemotherapy completion rates between groups. Multivariable logistic regression analysis indicated that independent factors predicting completion of adjuvant chemotherapy were body mass index, postoperative complications, year of treatment, and T-stage. Conclusion In this large cohort of NSCLC patients who received adjuvant chemotherapy, no association was found between surgical technique and adjuvant chemotherapy completion.