Operative complications and early mortality after induction therapy for lung cancer.
OBJECTIVE
Induction therapy for advanced lung cancer allows improvement of completeness of resection and survival. However, predictive risk factors for postoperative complications and early mortality remain controversial. We report our 14-year experience with this combined approach.


METHODS
One hundred and thirty-nine patients (100 males and 39 females) underwent induction therapy and surgery for stage IIIA and B lung cancer. The mean age was 58.4+/-7.7 years. We retrospectively collected demographic data, preoperative functional parameters, type of operation, associated disorders, staging, induction regimen (chemotherapy alone or associated with radiotherapy). Univariate and multivariate analyses were performed to identify predictors of postoperative complications and early mortality.


RESULTS
One hundred and nine patients received chemotherapy (mainly based on cisplatin and gemcitabine) and 30 received chemoradiotherapy (median dose 50Gy). Complications developed in 49 patients (35%). The most frequent was persistent air leakage (23-30% of the lobectomies), followed by cardiac complications, respiratory failure, and infections. Five patients (3.5%) died in the postoperative period and four of them had received pneumonectomy (mortality for pneumonectomy: 12.5%). The statistical analysis demonstrated that only pneumonectomy was associated with an increased mortality risk with no differences between intra- and extrapericardial dissection or right and left pneumonectomy.


CONCLUSIONS
Induction therapy seems to be associated with an increased incidence of air leakage; the risk of other complications is acceptable. Pneumonectomy is associated with an increased risk of mortality and should be performed in selected patients.
Venuta
Federico
F
Cattedra di Chirurgia Toracica, Policlinico Umberto I, Università di Roma La Sapienza, V.le del Policlinico, 00100 Rome, Italy. sofed@libero.it
Anile
Marco
M
Diso
Daniele
D
Ibrahim
Mohsen
M
De Giacomo
Tiziano
T
Rolla
Matilde
M
Liparulo
Valeria
V
Coloni
Giorgio F
GF
D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery / Q000628:therapy; D002945:Cisplatin / Q000627:therapeutic use; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care / Q000379:methods; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D000093542:Gemcitabine
D000970:Antineoplastic Agents; D011838:Radiation-Sensitizing Agents; D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine