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Eur J Cardiothorac Surg 2001;20:385-390
© 2001 Elsevier Science NL

Postoperative complications in relation with induction therapy for lung cancer

Christophe Doddolia, Pascal Thomasa, Xavier Thirionb, Yves Seréea, Roger Giudicellia, Pierre Fuentesa

a Department of Thoracic Surgery, Sainte-Marguerite University Hospital, Marseilles, France
b Department of Biostatistics and Medical Information, Sainte-Marguerite University Hospital, Marseilles, France

Received 9 October 2000; received in revised form 14 April 2001; accepted 19 April 2001.

Corresponding author. Tel.: +33-491-74-47-41; fax: +33-491-74-45-90
e-mail: cdoddoli{at}mail.ap-hm.fr

Objectives: The purpose of this study was to evaluate the risk of lung cancer surgery following induction chemotherapy and/or radiotherapy. Methods: This retrospective study included 69 patients treated from January 1990 to January 1998 for a primary lung cancer in whom surgery had been performed after induction treatment. Surgery had not been considered initially for the following reasons: N2 disease (IIIA, n=25); temporary functional impairment (two stages IB and two stages IIIA (N2), n=4); and doubtful resectability (stage IIIB (T4), n=40). The medical regimen resulted in combined radio-chemotherapy in 43 patients who received two to four cycles of chemotherapy (average 2.9±0.8 cycles) and 43±8 Gy (range 20–60 Gy), or chemotherapy alone in 26 patients (3±0.7 cycles). Results: Exploratory thoracotomy was performed in four patients (6%). The in-hospital mortality was 9% (n=6) from respiratory origin in all cases. There were four re-operations (6%): three for bronchial fistula and one for bleeding. Thirty-five patients (51%) required blood transfusion (4.5±3.8 cell packs). The incidence of early and delayed bronchial fistula after pneumonectomy was 15%. Thirteen patients had a postoperative pneumonia (19%). Conclusions: Surgery for lung cancer after induction chemotherapy and/or radiotherapy is associated with an increased risk. If the mortality seems ‘acceptable’, the morbidity rate, however, is high.

Key Words: Cancer • Surgery • Radiotherapy • Chemotherapy • Neoadjuvant • Complications




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