title: Morbidity and mortality after major pulmonary resections in patients with locally advanced stage IIIA non-small cell lung carcinoma who underwent induction therapy.
abstract: BACKGROUND
  The optimal treatment for patients with locally advanced stage IIIA non-small cell lung carcinoma (NSCLC) remains controversial, but induction therapy is increasingly used. The aim of this study was to evaluate mortality, morbidity, hospital stay and frequency of postoperative complications in stage IIIA NSCLC patients that underwent major pulmonary resections after neoadjuvant chemotherapy or chemoradiation.
  
  
  METHODS
  We conducted a retrospective analysis of all patients who underwent major pulmonary resections after induction therapy for locally advanced NSCLC from October 2009 to February 2014. Forty-one patients were included in the study.
  
  
  RESULTS
  Complete resection was achieved in 40 patients (97.5%). A complete pathologic response was seen in 10 patients (24.4%). Mean hospital stay was 17.7 days (ranged 5-129 days). Early (in-hospital) mortality occurred in 2.4% (one patient after bilobectomy), late (six months) mortality in 4.9% (two patients after right pneumonectomy and bilobectomy), and overall morbidity in 58.5% (24 patients). Postoperative complications included: bronchopleural fistula (BPF) with empyema - three patients, empyema without BPF - five patients, air leak - eight patients, atrial fibrillation - eight patients, pneumonia - eight patients, and lobar atelectasis - four patients.
  
  
  CONCLUSIONS
  Following neoadjuvant therapy for stage IIIA NSCLC, pneumonectomy can be performed with low early and late mortality (0% and 5.8%, respectively), bilobectomy is a high risk operation (16.7% early and 16.7% late mortality); and lobectomy a low risk operation (0% early and late mortality). The need for major pulmonary resections should not be a reason to exclude patients from a potentially curative procedure if it can be performed with acceptable morbidity and mortality rates at an experienced medical centre.
authors.affiliation: Department of Thoracic Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel. Electronic address: michaelp@asaf.health.gov.il.
authors.forename: Michael
authors.initials: M
authors.lastname: Peer
authors.affiliation: Department of Pulmonology, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Stav
authors.affiliation: Department of Oncology, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
authors.forename: Arnold
authors.initials: A
authors.lastname: Cyjon
authors.affiliation: Department of Pathology, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
authors.forename: Judith
authors.initials: J
authors.lastname: Sandbank
authors.affiliation: Institute of Diagnostic Imaging, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
authors.forename: Margarita
authors.initials: M
authors.lastname: Vasserman
authors.affiliation: Department of Anesthesiology, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
authors.forename: Zoya
authors.initials: Z
authors.lastname: Haitov
authors.affiliation: Department of Cardiothoracic Surgery, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Sasson
authors.affiliation: Department of Pathology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Letizia
authors.initials: L
authors.lastname: Schreiber
authors.affiliation: Department of Anesthesiology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Ezri
authors.affiliation: Department of Pulmonary Medicine, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Israel E
authors.initials: IE
authors.lastname: Priel
authors.affiliation: Department of Oncology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Henri
authors.initials: H
authors.lastname: Hayat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D060828:Induction Chemotherapy; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013510:Pulmonary Surgical Procedures; D015996:Survival Rate
keywords: Chemoradiation; Chemotherapy; Lobectomy; Lung cancer surgery; Pneumonectomy; Thoracotomy