Does induction treatment increase the risk of morbidity and mortality after pneumonectomy? A multicentre case-matched analysis

Background: The objective of this investigation was to compare postoperative morbidity and early and late mortality in patients after pneumonectomy for non-small-cell lung cancer (NSCLC) with or without induction neo-adjuvant therapy. Methods: This is an observational study performed on prospectively collected data at four tertiary referral centres (2000-2007). Of 225 pneumonectomies for NSCLC, 81 patients underwent neo-adjuvant chemotherapy. Several perioperative variables were used in identifying propensity score-matched pairs of patients with and without induction treatment. The matched groups were then compared in terms of morbidity, early (30-day or in-hospital) and 90-day mortality. Results: The overall cardiopulmonary morbidity, early mortality and 90-day mortality rates were 30% (67 patients), 7.1% (16 patients) and 9.8% (22 patients), respectively. Propensity score analysis yielded 56 well-matched pairs of patients with and without induction chemotherapy. The two groups had similar early and late mortality rates: four versus four (p = 1) and seven versus seven (p = 1), respectively. Moreover, the incidence of cardiopulmonary morbidity and bronchopleural fistula were also similar in both the groups: 19 versus 17 patients (Fisher's exact test p = 0.7) and two versus three patients (Fisher's exact test, p = 0.7), respectively. Twenty-one patients with induction chemo-radiotherapy were analysed separately and compared with well-matched counterparts without any induction treatment. No significant differences were identified in terms of early mortality (1 vs 0, p = 1), 90-day mortality (1 vs 0, p = 1), cardiopulmonary complications (5 vs 5, p = 1) and bronchopleural fistula (1 vs 1, p = 1). Conclusions: Current regimens of induction treatment do not seem to increase the risk of morbidity, early mortality and late mortality after pneumonectomy in properly selected patients. This study warrants confirmation from future multicentre prospective randomised trials powered on early outcomes.