Sleeve resection after induction therapy.
Preoperative chemoradiotherapy seems to improve the overall survival in locally advanced lung cancer but may also expose patients to an increased risk of postoperative complications. In particular, extended procedures, such as pneumonectomy, and especially right pneumonectomy, are associated with increased morbidity and mortality. Therefore, the extent of the procedure should be carefully weighed against the oncologic completeness of the resection. Among the potential sources of complications, special concern is given to bronchial healing, because of the impairment in bronchial blood flow caused by chemotherapy and radiation therapy. Accordingly, bronchial sleeve lobectomy after induction therapy was not widely accepted as an alternative to pneumonectomy, until the current authors showed that even complex bronchial and vascular procedures can be done safely and effectively in this setting. Many controversial issues still exist, and this article provides an updated summary of the different views and experiences.
Erino
A Rendina
AR
Division of Thoracic Surgery, Sant'Andrea Hospital, University La Sapienza Rome, Via di Grottarossa 1035-39, Rome 00189, Italy. erinoangelo.rendina@tin.it
Venuta
Federico
F
De Giacomo
Tiziano
T
Ibrahim
Mohsen
M
D'Andrilli
Antonio
A
Coloni
G Furio
GF
Ciccone
Anna M
AM
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002283:Carcinoma, Bronchogenic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012074:Remission Induction; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome