Postoperative complications in relation with induction therapy for lung cancer

• Published in: European journal of cardio-thoracic surgery 2001-08, Vol.20 (2), p.385-390
• Main Authors: Doddoli, Christophe, Thomas, Pascal, Thirion, Xavier, Serée, Yves, Giudicelli, Roger, Fuentes, Pierre
• Format: Article
• Language: English
• Subjects: Antineoplastic agents; Biological and medical sciences; Blood Transfusion; Cancer; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - surgery; Carcinoma, Non-Small-Cell Lung - therapy; Chemotherapy; Chemotherapy, Adjuvant; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Complications; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Lung Neoplasms - therapy; Medical sciences; Neoadjuvant; Pharmacology. Drug treatments; Pneumonectomy - adverse effects; Radiotherapy; Radiotherapy, Adjuvant; Retrospective Studies; Risk Assessment; Surgery
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(01)00764-3

Objectives: The purpose of this study was to evaluate the risk of lung cancer surgery following induction chemotherapy and/or radiotherapy. Methods: This retrospective study included 69 patients treated from January 1990 to January 1998 for a primary lung cancer in whom surgery had been performed after induction treatment. Surgery had not been considered initially for the following reasons: N2 disease (IIIA, n = 25); temporary functional impairment (two stages IB and two stages IIIA (N2), n = 4); and doubtful resectability (stage IIIB (T4), n = 40). The medical regimen resulted in combined radio-chemotherapy in 43 patients who received two to four cycles of chemotherapy (average 2.9±0.8 cycles) and 43±8 Gy (range 20–60 Gy), or chemotherapy alone in 26 patients (3±0.7 cycles). Results: Exploratory thoracotomy was performed in four patients (6%). The in-hospital mortality was 9% (n = 6) from respiratory origin in all cases. There were four re-operations (6%): three for bronchial fistula and one for bleeding. Thirty-five patients (51%) required blood transfusion (4.5±3.8 cell packs). The incidence of early and delayed bronchial fistula after pneumonectomy was 15%. Thirteen patients had a postoperative pneumonia (19%). Conclusions: Surgery for lung cancer after induction chemotherapy and/or radiotherapy is associated with an increased risk. If the mortality seems ‘acceptable’, the morbidity rate, however, is high.