Bronchovascular reconstruction for lung cancer: Does induction chemotherapy influence the outcomes?

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Abstract

Bronchoangioplastic interventions (BAIs) for lung cancer are challenging procedures associated with a high risk of postoperative morbidity and mortality. The role of induction chemotherapy (IC) in these patients is debated. We reviewed clinical records of patients who underwent a BAI between 1998 and 2009 using a prospective clinical and operative database. Among 47 patients (39 men; mean age, 66 years) who underwent BAI, 26 (55.3%) received IC for N2 disease or for locally advanced lung cancer. We performed 35 pulmonary artery (PA) sleeve resections (31 partial and 4 circumferential), 10 PA reconstructions with a pericardial patch (8 autologous, and 2 heterologous), and 2 PA reconstructions using heterologous conduit. The 30-day mortality rate was 4.2% (n = 2). Morbidity occurred in 19 (40.4%) patients; 5 patients (10.6%) had major complications (3 [6.4%] patients with fatal bronchovascular fistulas and 1 patient each with cardiac dislocation and acute respiratory distress syndrome) (2.2%). Fourteen patients (29.8%) had minor complications: 6 (12.7%) cardiac, 7 (14.9%) pulmonary, and 1 (2.2%) stroke. IC did not influence the complication rate. Overall 5-year survival and disease-free survival was 39.2% and 36.9%, respectively. Early pathologic stage and the absence of nodal involvement significantly influenced survival (p = 0.005 and p = 0.002, respectively). Patients receiving IC had a better prognosis (62.7% versus 10.7%; p = 0.0003). At multivariate analysis, IC influenced long-term survival (p = 0.003 [95% CI, 2.928.56]). BAIs are feasible and effective surgical procedures with acceptable morbidity and mortality. IC does not influence morbidity and allows good long-term outcomes.

Original languageEnglish
Pages (from-to)907-913
Number of pages7
JournalAnnals of Thoracic Surgery
Volume94
Issue number3
DOIs
Publication statusPublished - Sep 2012

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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