The Feasibility of Median Sternotomy With or Without Thoracotomy for Locally Advanced Non-Small Cell Lung Cancer Treated With Induction Chemoradiotherapy.
BACKGROUND
This study aimed to compare the morbidity and mortality of a median sternotomy approach and a lateral thoracotomy and to investigate the feasibility of a median sternotomy for locally advanced non-small cell lung cancer (NSCLC) after induction chemoradiotherapy.


METHODS
The medical records of patients with locally advanced NSCLC who underwent induction chemoradiotherapy followed by surgery at our institution between January 1999 and September 2014 were reviewed. We compared the morbidity and mortality of a median sternotomy approach and a lateral thoracotomy.


RESULTS
A total of 102 NSCLC patients were the subjects of this study. Among them, 31 patients underwent surgery with a median sternotomy approach and 71 patients underwent surgery with a lateral thoracotomy. Patients in the median sternotomy group had a significantly higher rate of postoperative arrhythmia than those in the lateral thoracotomy group (p = 0.0028). However, all the complications were manageable, and no treatment-related deaths occurred in the median sternotomy group. Regarding the prognosis, the 5-year overall survival rate was 72.7%, and the 2-year recurrence-free survival rate was 66.5% in the entire population. No significant differences in overall survival or recurrence-free survival were observed between the 2 approaches.


CONCLUSIONS
Whereas the lateral thoracotomy approach is a standard procedure, our experience suggests that a median sternotomy approach for locally advanced NSCLC after induction chemoradiotherapy is a feasible procedure and can be a surgical option.
Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
Hiroki
H
Sato
Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan; Department of Clinical Genomic Medicine, Okayama University Hospital, Okayama, Japan. Electronic address: toyooka@md.okayama-u.ac.jp.
Shinichi
S
Toyooka
Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
Junichi
J
Soh
Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan.
Katsuyuki
K
Hotta
Department of Radiology, Okayama University Hospital, Okayama, Japan.
Kuniaki
K
Katsui
Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
Hiromasa
H
Yamamoto
Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
Seiichiro
S
Sugimoto
Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
Takahiro
T
Oto
Department of Radiology, Okayama University Hospital, Okayama, Japan.
Susumu
S
Kanazawa
Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan.
Katsuyuki
K
Kiura
Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
Shinichiro
S
Miyoshi
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D059248:Chemoradiotherapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D056346:Sternotomy; D013908:Thoracotomy