There are few data in the literature about how soon after surgery a patient begins adjuvant chemotherapy, although most trials seem to start after a post-surgical interval of 4-6 weeks. A recent study reported that 26 patients, who underwent thoracoscopic (video-assisted thoracic surgery, VATS) lobectomy, receiving chemotherapy, 73% completed a full course on schedule and 85% received all intended cycles. (Nicastri et al, 2008) In another study, complete resection was performed by thoracotomy in 43 patients and by thoracoscopy in 57 patients, compared with thoracotomy, patients undergoing thoracoscopic lobectomy had significantly fewer delayed (18% versus 58%, P < 0.001) and reduced (26% versus 49%, P = 0.02) chemotherapy doses. A higher percentage of patients undergoing thoracoscopic resection received 75% or more of their planned adjuvant regimen without delayed or reduced doses (61% versus 40%, P = 0.03). There were no significant differences in time to initiation of chemotherapy or toxicity. (Peterson et al, 2007) In comparison, the Cancer and Leukemia Group B trial 9633 reported that 57% of patients received full-dose chemotherapy (Strauss et al, 2008) and the Intergroup JBR.10 trial reported that 55% of patients had at least 1 dose delay. (Winton et al, 2005) Approximately 34% of patients in the Adjuvant Lung Project Italy series chemotherapy wing received all scheduled doses without adjustment or delay; 69% completed their treatments with or without adjustments or delay.(Scagliotti et al, 2003) It is conceivable that patients who undergo VATS may have a quicker recovery and in general more strength to tolerate chemotherapy. There are theoretic survival benefits to starting chemotherapy immediately after surgery because the body's tumor burden should be lowest, and tumor growth fastest, at this time. Thus, chemotherapy administered immediately post-surgery would be most effective, assuming that wound healing is adequate. (Nicastri et al, 2008)