title: Impact of induction therapy on airway complications after sleeve lobectomy for lung cancer.
abstract: BACKGROUND
  Sleeve lobectomy is a valid alternative to pneumonectomy for the treatment of centrally located operable non-small cell lung cancer (NSCLC), but concern has been evoked regarding a potentially increased risk of bronchial anastomosis complications after induction therapy. This study examined the impact of induction therapy on airway healing after sleeve lobectomy for NSCLC.
  
  
  METHODS
  Bronchial anastomosis complications were recorded with respect to the induction regimen applied (neoadjuvant chemotherapy vs chemoradiotherapy) in a consecutive series of patients with sleeve lobectomy for NSCLC.
  
  
  RESULTS
  Ninety-nine patients underwent sleeve resection, 28 of them after induction therapy. Twelve patients received chemotherapy alone, and 16 patients had radiochemotherapy. There were no significant differences in postoperative 90-day mortality (3.6% vs 2.8%) and morbidity (54% vs 49%) for patients with and without induction therapy. Bronchial anastomosis complications occurred in 3 patients (10.8%) with neoadjuvant therapy and in 2 (2.8%) without (p = 0.3). In the induction therapy group, two bronchial stenoses occurred after radiochemotherapy and one bronchopleural fistula after chemotherapy alone. In patients without induction therapy, one bronchial stenosis and one bronchopleural fistula were observed. All bronchial stenoses were successfully treated by dilatation, and both bronchopleural fistulas occurring after right lower lobectomy were successfully treated by reoperation and completion sleeve bilobectomy with preservation of the upper lobe.
  
  
  CONCLUSIONS
  Sleeve lobectomy for NSCLC can be safely performed after induction chemotherapy and radiochemotherapy with mortality and incidence of airway complications similar to that observed in nonpretreated patients. The treatment of airway complications does not differ for patients with and without induction therapy.
authors.affiliation: Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. michel.gonzalez@chuv.ch
authors.forename: Michel
authors.initials: M
authors.lastname: Gonzalez
authors.forename: Yann
authors.initials: Y
authors.lastname: Litzistorf
authors.forename: Thorsten
authors.initials: T
authors.lastname: Krueger
authors.forename: Sotirios Georgios
authors.initials: SG
authors.lastname: Popeskou
authors.forename: Oscar
authors.initials: O
authors.lastname: Matzinger
authors.forename: Hans-Beat
authors.initials: HB
authors.lastname: Ris
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gronchi
authors.forename: Alban
authors.initials: A
authors.lastname: Lovis
authors.forename: Solange
authors.initials: S
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D060828:Induction Chemotherapy / Q000379:methods*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome