Neoadjuvant chemotherapy is a risk factor for bronchopleural fistula after pneumonectomy for non-small cell lung cancer.
BACKGROUND
Performing pneumonectomy after neoadjuvant chemotherapy is still controversial. Bronchopleural fistula is a major complication after pneumonectomy. In this study the effect of neoadjuvant chemotherapy on postpneumonectomy bronchopleural fistula was investigated.


METHODS
A retrospective review of patients who underwent pneumonectomy for non-small cell lung cancer from January 2005 to December 2011 was undertaken. The major complications and operative mortality were analyzed and compared between the patients having neoadjuvant chemotherapy and patients having surgery only.


RESULTS
One hundred and seventy-seven pneumonectomies (77 right and 100 left) were performed during the study period and 49 of these patients (27.7%) received neoadjuvant chemotherapy. Median age was 60 years (range, 32 to 80). The bronchopleural fistula rate was 26.5% (13/49) in the neoadjuvant group versus 3.1% (4/128) in the surgery alone group (p = 0.029). The bronchopleural fistula rate was 16.9% (13/77) in the right pneumonectomy group vs. 4% (4/100) in the left pneumonectomy group (p = 0.004). Overall operative mortality was 5.6%. Mortality in the neoadjuvant group was 8.2% vs. 4.7% in the surgery only group (p = 0.37).


CONCLUSIONS
Neoadjuvant chemotherapy and right pneumonectomy is a major risk factor for bronchopleural fistula. Especially right pneumonectomy should be avoided after induction therapy.
Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Research and Training Hospital, Izmir, Turkey.
Ozgur
O
Samancilar
Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Research and Training Hospital, Izmir, Turkey.
Seyda Ors
SO
Kaya
Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Research and Training Hospital, Izmir, Turkey.
Ozan
O
Usluer
Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Research and Training Hospital, Izmir, Turkey.
Taner
T
Ozturk
bronchopleural fistula; neoadjuvant chemotherapy; pneumonectomy