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Enhanced recovery after thoracic surgery is associated with improved adjuvant chemotherapy completion for non-small

David B Nelson¹, Reza J Mehran¹, Kyle G Mitchell¹

¹Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.

The Journal of Thoracic and Cardiovascular Surgery

|April 25, 2019

Abstract

Objective:

Enhanced recovery after surgery integrates multiple evidence-based interventions to accelerate postoperative recovery. We hypothesized that enhanced recovery after surgery would also facilitate adjuvant chemotherapy for non-small cell lung cancer.

Methods:

An enhanced recovery after surgery pathway was implemented at a single institution, starting with a transitional rollout in 2012 and full rollout in 2015. Patients with clinical stage I or II non-small cell lung cancer without induction therapy and who were pathologic nodal positive or had 5-cm or larger tumor size were selected for analysis. Dates analyzed were pre-enhanced recovery after surgery (2006-2011), transitional (2012-8/2015), and enhanced recovery after surgery (9/2015-2017). Interrupted time series was used to analyze trends in time to receive adjuvant chemotherapy after resection by era. Logistic regression was used to determine factors associated with receiving 4 or more cycles of adjuvant chemotherapy.

Results:

A total of 471 patients were identified. The interval between lung resection and commencing adjuvant chemotherapy was progressively shorter after the transition era (P = .041). The rate of receiving adjuvant chemotherapy progressively increased (from 40% pre-enhanced recovery after surgery, to 50% transition era, to 62% enhanced recovery after surgery era, P < .001). Multivariable regression revealed the enhanced recovery after surgery era (odds ratio, 3.6, P < .001), the transitional era (odds ratio, 2.01, P = .007), pN status, tumor grade and histology, age, and preoperative performance status were associated with completing adjuvant therapy. The surgical approach, whether open or thoracoscopic, was not associated with completing adjuvant chemotherapy.

Conclusions:

Enhanced recovery after surgery was associated with facilitated delivery of adjuvant chemotherapy, with a shortened interval to receive adjuvant chemotherapy and a higher rate of receiving 4 or more cycles.

Keywords:

adjuvant chemotherapy enhanced recovery lung cancer surgery

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