Pneumonectomy After Chemotherapy: Morbidity, Mortality, and Long-Term Outcome
| Autor: | Jean-Yves Collet, Mohamed S. Boudaya, Maurizio Salvi, Sophie Camilleri-Broët, Marco Alifano, Carmen Dinu, Jean-François Regnard |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Lung Neoplasms Multivariate analysis medicine.medical_treatment Bronchopleural fistula Antineoplastic Agents Disease Carboplatin law.invention Pneumonectomy Postoperative Complications Randomized controlled trial law Carcinoma Non-Small-Cell Lung medicine Humans Hospital Mortality Aged Neoplasm Staging Randomized Controlled Trials as Topic Chemotherapy Univariate analysis business.industry Induction chemotherapy Middle Aged medicine.disease Survival Analysis Neoadjuvant Therapy Surgery Treatment Outcome Female France Cisplatin Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 85:1866-1873 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2008.01.103 |
| Popis: | Background Results of pneumonectomy after chemotherapy are controversial, and the procedure is often considered as potentially dangerous. Methods Records of patients who underwent pneumonectomy after chemotherapy for non-small cell lung cancer in a single institution in a 6-year period were reviewed retrospectively. Results One hundred eighteen patients had pneumonectomy after chemotherapy. Indications for preoperative chemotherapy were N2 disease, 74; potentially resectable T4 disease, 17; doubtful resectability, 18; stage IV disease (nodule on another ipsilateral lobe), 4; and participation in a randomized trial on induction chemotherapy in initial stages, 5. Chemotherapy protocols were platinum-based. Imaging reevaluation showed complete, partial, minor response, and disease stability in 0, 24, 39, and 55 patients, respectively. Operative mortality was 5.9% (7 of 118), consisting of 4 of 54 after pneumonectomy, and 3 of 64 after left pneumonectomy. Bronchopleural fistula caused one death. No factor among those evaluated (sex, age, comorbidities, forced expiratory volume in 1 second, symptoms, side and location of tumor; indication for operation, number of cycles, and response to chemotherapy; extent of resection, TNM status, pathologic stage) predicted postoperative death. Median and overall 5-year survival was 22 months and 23.7%, respectively. At univariate analysis, pathologic stage, T status, and the occurrence of postoperative complications influenced 5-year survival. At multivariate analysis, T status ( p = 0.0054), the occurrence of postoperative complications ( p = 0.0015), and clinical response to induction chemotherapy ( p = 0.028) were identified as independent predictors of 5-year survival. Conclusions Pneumonectomy after chemotherapy has acceptable mortality. Long-term results are encouraging. |
| Databáze: | OpenAIRE |
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