title: POINT: Operative risk of pneumonectomy--influence of preoperative induction therapy.
abstract: BACKGROUND
  Prior data indicate increased perioperative morbidity and mortality in patients receiving induction chemoradiotherapy before pneumonectomy for lung cancer.
  
  
  OBJECTIVE
  We reviewed a consecutive series of pneumonectomies to determine the impact of induction therapy on operative mortality.
  
  
  RESULTS
  Over a 15-year period, 183 patients underwent pneumonectomy for lung cancer. Forty-six received combined preoperative radiochemotherapy (25.2%), and 137 patients underwent resection only. Indications for induction therapy were stage IIB disease in 1, IIIA in 35, IIIB in 8, and IV in 2 patients. Patients receiving induction therapy were younger (mean age 58.4 vs 61.9 years; P = .033), had less heart disease (6.5 vs 26.3%; P = .0035), higher preoperative forced expiratory volume in 1 second (2.48 vs 2.13 L; P = .0018), a lower rate of endobronchial tumor (34.8 vs 67.2%; P = .0002), and underwent intrapericardial procedures more often (71.7 vs 43.1%; P = .0011). Hospital mortality was 4.3 % (2/46) after preoperative therapy and 6.6% (9/137) after resection only (P = .73); the difference in cardiopulmonary morbidity was not significant (51.1% vs 40.4%; P = .22). Induction did not predict hospital mortality after adjustment for a propensity score derived from nonoperative and operative variables correlated with neoadjuvant therapy.
  
  
  CONCLUSIONS
  A regimen of induction radiation and chemotherapy does not increase the operative mortality of pneumonectomy in carefully selected patients.
authors.affiliation: Division of Thoracic Surgery and Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. hgaissert@partners.org
authors.forename: Henning A
authors.initials: HA
authors.lastname: Gaissert
authors.forename: Dong Yoon
authors.initials: DY
authors.lastname: Keum
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.forename: Marek
authors.initials: M
authors.lastname: Ancukiewicz
authors.forename: Eric
authors.initials: E
authors.lastname: Monroe
authors.forename: Dean M
authors.initials: DM
authors.lastname: Donahue
authors.forename: John C
authors.initials: JC
authors.lastname: Wain
authors.forename: Michael
authors.initials: M
authors.lastname: Lanuti
authors.forename: James S
authors.initials: JS
authors.lastname: Allan
authors.forename: Noah C
authors.initials: NC
authors.lastname: Choi
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D016017:Odds Ratio; D011013:Pneumonectomy / Q000401:mortality*; D012307:Risk Factors