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The Journal of Cardiovascular Surgery 2002 August;43(4):539-44


language: English

Postoperative complications of lung resection after induction chemotherapy using Paclitaxel (and radiotherapy) for advanced non-small lung cancer

Torre W., Sierra A.

Service of General Thoracic Surgery Clinica Universitaria Universidad de Navarra, Pamplona, Spain


Back­ground. ­Locally ­advanced non-­small-­cell ­lung car­ci­noma is cur­rently ­treated by mul­ti­dis­ci­pli­nary pro­to­cols ­using a com­bi­na­tion of chem­o­therapy, radio­therapy and sur­gery. How­ever the ­best ­strategy for ­applying ­these ther­a­peutic meas­ures has not yet ­been estab­lished. One of the dif­fi­cul­ties of ­using ­these ­forms of treat­ment is ­their tox­icity. Our aim was to deter­mine ­whether the post­op­er­a­tive ­course of the dis­ease can be influ­enced by pre­op­er­a­tive chem­o­therapy in any way.
­Methods. Nine­teen ­patients ­were sur­gi­cally ­treated ­after ­receiving induc­tion treat­ment ­between ­October 1996 and ­October 1998. The indi­ca­tions for ­giving induc­tion treat­ment ­were: ­stage III dis­ease in 12 ­patients (1 Pan­coast ­tumor), ­lung ­cancer and sol­i­tary ­brain metas­tasis in 4 ­patients, ­double pri­mary ­lung ­cancer in 3 ­patients (1 syn­chro­nous and 2 met­a­chro­nous). Var­i­ables ­were the chem­o­therapy treat­ment ­time ­interval ­from the begin­ning to sur­gery, the ­type of sur­gery, post­op­er­a­tive mor­tality and mor­bidity. ­Mean age was 55.9 ­years old (­range ­between 25 and 70 ­years). Pre­dom­i­nant ­gender was ­male (18 men and 1 ­woman). Neo­ad­ju­vant treat­ment con­sisted of chem­o­therapy in all ­patients (Pac­li­taxel, Cys­platin and Vin­o­rel­bine in ­cycles for a ­mean ­period of 3 ­months), and radio­therapy (14 ­patients). Pul­mo­nary resec­tions ­were: pneu­mo­nec­tomy (2 ­patients), lobec­tomy (16 ­patients) and ­wedge resec­tion (1 ­patient). ­There ­were no explor­a­tory thor­a­cot­o­mies. Bron­cho­plasty pro­ce­dures ­were nec­es­sary in 5 ­cases and angio­plasty in 5. Car­di­o­pul­mo­nary ­bypass was nec­es­sary in 1 ­case in ­order to ­resect an infil­trated pul­mo­nary ­vein. Intra­op­er­a­tive radio­therapy (­IORT) was ­used in 9 ­cases.
­Results. Com­pli­ca­tions ­occurred in the imme­diate post­op­er­a­tive ­period in 9 ­patients: 1 postp­neu­mo­nec­tomy res­pir­a­tory dis­tress syn­drome, 2 bron­cho­pleural fis­tulae, 4 pro­longed air ­leaks, 1 com­plete dehis­cence of the thor­a­cotomy ­scar and 1 col­itis ­caused by ­anaerobes. The post­op­er­a­tive mor­tality (­within 30 ­days) was 2 ­patients (10.5%): 1 ­died ­from bron­cho­pleural fis­tula and the ­other ­from postp­neu­mo­nec­tomy res­pir­a­tory dis­tress syn­drome. How­ever, if we ­take ­into ­account the ­fact ­that the ­case of anaer­obic col­itis ­also ­ended ­with the ­patient’s ­death on the 48th post­op­er­a­tive day, and we ­include it in the mor­tality ­rate, the ­final mor­tality is ­higher (15.8%).
Con­clu­sions. Sur­gery for non-­small-­cell ­lung car­ci­noma has to be con­sid­ered a ­high-­risk pro­ce­dure. But, if ­patients are ­selected appro­pri­ately and the per­i­op­er­a­tive man­age­ment is sat­is­fac­tory, rea­son­able ­rates of mor­bidity and mor­tality can be ­achieved. ­More ­studies are ­needed in ­order to ­define the ­exact ­role of ­these ther­a­peutic meas­ures.

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