Morbidity and mortality after induction chemotherapy followed by surgery in IIIa-N2 non small cell lung cancer.
OBJECTIVE
To evaluate the frequency and risk of postoperative complications and mortality in patients with IIIa-N2 non small cell lung cancer after induction chemotherapy and surgery.


METHODS
In a surgical database records from ninety two patients, operated between January 1, 2000 and December 31, 2006 were reviewed. Univariate analysis was used to identify predictors of postoperative complications and in-hospital mortality.


RESULTS
All cases were histologically confirmed stage IIIa-N2. All patients received preoperative platinum based chemotherapy without radiotherapy. Pneumonectomy was performed in 20 cases (23.5%), from which 9 right sided. (Bi)lobectomy was performed in 53 cases (62.4%) and sleeve lobectomy in 11 cases (17.2%). One wedge resection was performed (1.2%). In 7 cases (7.6%) only an exploration was done. Complications developed in 35 patients (38%). Major complications in 15 patients (16%). No bronchopleural fistulae were observed. Analysis identified increased age and high physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) as a risk factor to develop complications, and a high simplified comorbidity score as a risk factor to develop a major complication. Higher age, Charlson comorbidity index, simplified comorbidity score and POSSUM were a risk factor for developing pneumonia.


CONCLUSIONS
Although surgery after induction therapy for IIIa-N2 NSCLC can be done with a morbidity and mortality comparable to surgery alone, it remains a high risk operation. It should therefore be performed in a center with experience. Bronchial stump protection should be used whenever there is an increased risk for developing a bronchopleural fistula. In deciding whether to do surgery or radiotherapy one should keep in mind the feasibility of performing a complete resection together with a preoperative assessment to predict complications and mortality. For the preoperative assessment several scoring systems can be used from which we find the simplified comorbidity score most useful.
Borreman
Ph
P
Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
De Leyn
P
P
Decaluwé
H
H
Moons
J
J
Van Raemdonck
D
D
Nafteux
Ph
P
Coosemans
W
W
Lerut
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001530:Belgium / Q000453:epidemiology; D001707:Biopsy, Needle; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
D000970:Antineoplastic Agents