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Surgical outcomes and complications of pneumonectomy after induction therapy for non-small cell lung cancer

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Abstract

Objectives

Although surgical resection after induction therapy (IT) for locally advanced non-small cell lung cancer (NSCLC) is a possible treatment option, pneumonectomy may be avoided owing to high-surgical risks. However, reports exist that pneumonectomy after IT has acceptable safety and favorable outcomes. We reviewed pneumonectomies after IT in terms of surgical outcomes, perioperative management, and complications.

Methods

Between April 2004 and March 2015, 15 consecutive pneumonectomies were performed for locally advanced NSCLC after IT. Surgical outcomes, perioperative management, and complications were retrospectively reviewed.

Results

Thirteen patients were men, and 6 pneumonectomies were right-sided. One pneumonectomy was performed after induction chemotherapy and 14 followed induction chemoradiation. In all 15 cases the bronchial stumps were covered with autologous tissues. Pedunculated mediastinal fat pad and pedunculated intercostal muscles were used in 4 and 11 cases, respectively. Although postoperative complications were seen in 12 patients (80.0%), with major complications (Clavien–Dindo classification ≥ IIIa) in 5 patients (33.3%), there were no deaths within 30 days after pneumonectomy. Overall 3- and 5-year survivals were 80.0 and 57.1%, respectively.

Conclusions

Owing to high-surgical risks and complication rates, careful surgical technique and postoperative management are essential for successful pneumonectomy after IT.

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Acknowledgements

The authors thank Reiko Moriwake for laborious efforts in data management.

Funding

No funding was provided.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan

    Hidenao Kayawake, Norihito Okumura, Keiji Yamanashi, Yasuhiro Otsuki, Ayuko Takahashi, Takashi Nakashima & Tomoaki Matsuoka

  2. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan

    Hidenao Kayawake

  3. Department of Radiation Therapy, Kurashiki Central Hospital, Okayama, Japan

    Satoshi Itasaka

  4. Department of Respiratory Medicine, Kurashiki Central Hospital, Okayama, Japan

    Hiroshige Yoshioka

  5. Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan

    Hiroshige Yoshioka

Authors
  1. Hidenao Kayawake
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  2. Norihito Okumura
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  3. Keiji Yamanashi
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  4. Yasuhiro Otsuki
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  5. Ayuko Takahashi
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  6. Satoshi Itasaka
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  7. Hiroshige Yoshioka
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  8. Takashi Nakashima
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  9. Tomoaki Matsuoka
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Corresponding author

Correspondence to Norihito Okumura.

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The authors have nothing to disclose with regard to commercial support. No potential conflicts exist.

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Kayawake, H., Okumura, N., Yamanashi, K. et al. Surgical outcomes and complications of pneumonectomy after induction therapy for non-small cell lung cancer. Gen Thorac Cardiovasc Surg 66, 658–663 (2018). https://doi.org/10.1007/s11748-018-0980-4

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  • DOI: https://doi.org/10.1007/s11748-018-0980-4

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