Advertisement

Does Induction Therapy Increase Anastomotic Complications in Bronchial Sleeve Resections?

  • Giovanni M. ComacchioEmail author
  • Marco Schiavon
  • Danila Azzolina
  • Marco Mammana
  • Giuseppe Marulli
  • Andrea Zuin
  • Enrico Verderi
  • Nicola Monaci
  • Laura Bonanno
  • Giulia Pasello
  • Federico Rea
Original Scientific Report

Abstract

Background

Sleeve lobectomy represents a safe and effective treatment for central NSCLC to avoid the risks of pneumonectomy. Induction therapy (IT) may be indicated in advanced stages; however, the effect of IT on bronchial anastomoses remains uncertain. The purpose of the study was to evaluate the impact of IT on the complications of the anastomoses.

Methods

Between 2000 and 2012, 159 consecutive patients were submitted to sleeve lobectomy for NSCLC at our Institution. We retrospectively compared the results of patients who underwent IT before operation with those who received upfront surgery.

Results

In the study period, 49 (30.8%) patients received IT (37 chemotherapy, 1 radiotherapy and 11 chemo-radiotherapy) and 110 (69.2%) patients were directly submitted to surgery (S). The two groups were comparable for sex, age, comorbidities, ASA score, pulmonary function, side, type of procedure and histology. Pathological stage was statistically higher for IT group (p = 0.001). No differences between IT and S groups were observed in terms of post-operative mortality (2% vs 0%, p = NS), morbidity (45% vs 38%, p = NS), including early (6% vs 9%, p = NS) and long-term (16% vs 14%, p = NS) bronchial complication rates. Patients undergoing induction mediastinal radiotherapy, however, are at higher risk of bronchial complications.

Conclusion

In our experience, the use of induction chemotherapy did not significantly increase mortality and morbidity rates, in particular, neither for early nor for late anastomotic complications. We, therefore, conclude that sleeve lobectomy after induction chemotherapy is safe and reliable procedure for the treatment of locally advanced NSCLC.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

References

  1. 1.
    Ma Z, Dong A, Fan J et al (2007) Does sleeve lobectomy concomitant with or without pulmonary artery reconstruction (double sleeve) have favorable results for non-small cell lung cancer compared with pneumonectomy? A meta-analysis. Eur J Cardiothorac Surg 32:20–28CrossRefGoogle Scholar
  2. 2.
    Ferguson MK, Lehman AG (2003) Sleeve lobectomy or pneumonectomy: optimal management strategy using decision analysis techniques. Ann Thorac Surg 76:1782–1788CrossRefGoogle Scholar
  3. 3.
    Okada M, Yamagishi H, Satake S et al (2000) Survival related to lymph node involvement in lung cancer after sleeve lobectomy compared with pneumonectomy. J Thorac Cardiovasc Surg 119:814–819CrossRefGoogle Scholar
  4. 4.
    Martins RG, D’Amico TA, Loo BW Jr et al (2012) The management of patients with stage IIIA non-small cell lung cancer with N2 mediastinal node involvement. J Natl Compr Cancer Netw 10:599–613CrossRefGoogle Scholar
  5. 5.
    Ripley RT, Rusch VW (2013) Role of induction therapy: surgical resection of non-small cell lung cancer after induction therapy. Thorac Surg Clin 23:273–285CrossRefGoogle Scholar
  6. 6.
    Rea F, Marulli G, Schiavon M et al (2008) A quarter of a century experience with sleeve lobectomy for non-small cell lung cancer. Eur J Cardiothorac Surg 34:488–492CrossRefGoogle Scholar
  7. 7.
    Gonzalez M, Litzistorf Y, Krueger T et al (2013) Impact of induction therapy on airway complications after sleeve lobectomy for lung cancer. Ann Thorac Surg 96:247–252CrossRefGoogle Scholar
  8. 8.
    Milman S, Kim AW, Warren WH et al (2009) The incidence of perioperative anastomotic complications after sleeve lobectomy is not increased after neoadjuvant chemoradiotherapy. Ann Thorac Surg 88:945–950CrossRefGoogle Scholar
  9. 9.
    Gómez-Caro A, Boada M, Reguart N et al (2012) Sleeve lobectomy after induction chemoradiotherapy. Eur J Cardiothorac Surg 41:1052–1058CrossRefGoogle Scholar
  10. 10.
    Bagan P, Berna P, Brian E et al (2009) Induction chemotherapy before sleeve lobectomy for lung cancer: immediate and long-term results. Ann Thorac Surg 88:1732–1735CrossRefGoogle Scholar
  11. 11.
    Burfeind WR Jr, D’Amico TA, Toloza EM et al (2005) Low morbidity and mortality for bronchoplastic procedures with and without induction therapy. Ann Thorac Surg 80:418–421CrossRefGoogle Scholar
  12. 12.
    Fadel E, Yildizeli B, Chapelier AR et al (2002) Sleeve lobectomy for bronchogenic cancers: factors affecting survival. Ann Thorac Surg 74:851–858CrossRefGoogle Scholar
  13. 13.
    Hamad AM, Marulli G, Rizzardi G et al (2009) Multiple-running suture technique for bronchial anastomosis in difficult sleeve resection. Ann Thorac Surg 87:975–976CrossRefGoogle Scholar
  14. 14.
    Rendina EA, Venuta F, Ricci C (1992) Effects of low-dose steroids on bronchial healing after sleeve resection. A clinical study. J Thorac Cardiovasc Surg 104:888–891Google Scholar
  15. 15.
    Vallières E, Shepherd FA, Crowley J (2009) The IASLC lung cancer staging project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 4:1049–1059CrossRefGoogle Scholar
  16. 16.
    Senan S, De Ruysscher D, Giraud P et al (2004) Literature-based recommendations for treatment planning and execution in high-dose radiotherapy for lung cancer. Radiother Oncol 71:139–146CrossRefGoogle Scholar
  17. 17.
    Yamamoto R, Tada H, Kishi A et al (2000) Effects of preoperative chemotherapy and radiation therapy on human bronchial blood flow. J Thorac Cardiovasc Surg 119:939–945CrossRefGoogle Scholar
  18. 18.
    Rendina EA, Venuta F, De Giacomo T et al (1997) Safety and efficacy of bronchovascular reconstruction after induction chemotherapy for lung cancer. J Thorac Cardiovasc Surg 114:830–835CrossRefGoogle Scholar
  19. 19.
    Storelli E, Tutic M, Kestenholz P et al (2012) Sleeve resections with unprotected bronchial anastomoses are safe even after neoadjuvant therapy. Eur J Cardiothorac Surg 42:77–81CrossRefGoogle Scholar
  20. 20.
    Tedder M, Anstadt MP, Tedder SD et al (1992) Current morbidity, mortality, and survival after bronchoplastic procedures for malignancy. Ann Thorac Surg 54:387–391CrossRefGoogle Scholar
  21. 21.
    Veronesi G, Solli PG, Leo F et al (2002) Low morbidity of bronchoplastic procedures after chemotherapy for lung cancer. Lung Cancer 36:91–97CrossRefGoogle Scholar
  22. 22.
    Saji H, Furukawa K, Tsutsui H et al (2010) Outcomes of airway stenting for advanced lung cancer with central airway obstruction. Interact Cardiovasc Thorac Surg 11:425–428CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Giovanni M. Comacchio
    • 1
    Email author
  • Marco Schiavon
    • 1
  • Danila Azzolina
    • 2
  • Marco Mammana
    • 1
  • Giuseppe Marulli
    • 3
  • Andrea Zuin
    • 1
  • Enrico Verderi
    • 1
  • Nicola Monaci
    • 1
  • Laura Bonanno
    • 4
  • Giulia Pasello
    • 4
  • Federico Rea
    • 1
  1. 1.Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular SciencesUniversity of PadovaPaduaItaly
  2. 2.Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPaduaItaly
  3. 3.Thoracic Surgery Unit, Department of Emergency and Organ TransplantationUniversity HospitalBariItaly
  4. 4.Second Medical Oncology UnitIstituto Oncologico Veneto, IRCCSPaduaItaly

Personalised recommendations