ABSTRACT
Background: The standard of care for stage I non-small cell lung cancer (NSCLC) is surgical resection. Stereotactic ablative radiotherapy (SABR) plays an important role in the management of early NSCLC in patients who are poor operative candidates, or more recently during the COVID-19 pandemic, as a bridge to surgery, when operating room access is limited. The impact of preoperative SABR on surgical resection has not been extensively explored in terms of length of hospital stay (LOS) and difficulty of surgical resection (DSR). Our unique published prospective MISSILE study afforded the opportunity to examine this. Methods: LOS and perioperative outcomes were assessed for patients with stage I NSCLC who received preoperative SABR and subsequent surgical resection (RS) within 10 weeks and compared with a similar cohort who underwent surgery alone (S) from 2014 to 2017 using a propensity-score matched analysis. DSR was assessed on the basis of operative time, blood transfusions, conversion rates (CR) and increased sublobar to lobar resection (SL). Results: Forty patients in the RS cohort were compared with 168 patients in the S cohort. Univariable and multivariable logistic regression models were generated as a comparison for all patients (n = 208). LOS was similar between the cohorts (mean 5.2 [standard deviation (SD) 4.7] d v. 4.3 [SD 2.2] d, p = 0.90). There were no differences between cohorts for blood transfusions (0% v. 0%), mean operative time (2.4 [SD 1.0] h v. 2.5 [SD 1.2] h, p = 0.60), conversion rates (21.9% v. 18.8%, p = 0.76) or increased SL (9.4% v. 0%, p = 0.24). Three patients who received radiotherapy did not proceed to surgery, 1 because of concerns of radiation pneumonitis. Conclusion: Preoperative SABR in patients with stage I NSCLC does not have a significant impact on the DSR and LOS.