Does Induction Therapy Increase Anastomotic Complications in Bronchial Sleeve Resections?

Giovanni M Comacchio, Marco Schiavon, Danila Azzolina, Marco Mammana, Giuseppe Marulli, Andrea Zuin, Enrico Verderi, Nicola Monaci, Laura Bonanno, Giulia Pasello, Federico Rea

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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.

Original languageEnglish
Pages (from-to)1385-1392
Number of pages8
JournalWorld Journal of Surgery
Volume43
Issue number5
DOIs
Publication statusPublished - May 2019

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Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical/adverse effects
  • Bronchi/surgery
  • Carcinoma, Non-Small-Cell Lung/surgery
  • Female
  • Humans
  • Induction Chemotherapy/adverse effects
  • Lung Neoplasms/surgery
  • Male
  • Middle Aged
  • Pneumonectomy/adverse effects
  • Retrospective Studies

Cite this

Comacchio, G. M., Schiavon, M., Azzolina, D., Mammana, M., Marulli, G., Zuin, A., Verderi, E., Monaci, N., Bonanno, L., Pasello, G., & Rea, F. (2019). Does Induction Therapy Increase Anastomotic Complications in Bronchial Sleeve Resections? World Journal of Surgery, 43(5), 1385-1392. https://doi.org/10.1007/s00268-019-04908-0