Postoperative complications in relation with induction therapy for lung cancer.
OBJECTIVE
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.
Doddoli
C
C
Department of Thoracic Surgery, Sainte-Marguerite University Hospital, Marseilles, France. cdoddoli@mail.ap-hm.fr
Thomas
P
P
Thirion
X
X
Serée
Y
Y
Giudicelli
R
R
Fuentes
P
P
D001803:Blood Transfusion; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D011013:Pneumonectomy / Q000009:adverse effects*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment