Morbidity and mortality after neoadjuvant therapy for lung cancer: The risks of right pneumonectomy Journal Article

Authors: Martin, J.; Ginsberg, R. J.; Abolhoda, A.; Bains, M. S.; Downey, R. J.; Korst, R. J.; Weigel, T. L.; Kris, M. G.; Venkatraman, E. S.; Rusch, V. W.
Article Title: Morbidity and mortality after neoadjuvant therapy for lung cancer: The risks of right pneumonectomy
Abstract: Background. The risks of complications in patients undergoing thoracotomy after neoadjuvant therapy for nonsmall cell lung cancer remain controversial. We reviewed our experience to define it further. Methods. All patients undergoing thoracotomy after induction chemotherapy from 1993 through 1999 were reviewed. Univariate and multivariate methods for logistic regression model were used to identify predictors of adverse events. Results. Induction chemotherapy included mitomycin, vinblastine, and cisplatin (179 patients), carboplatin and paclitaxel (152 patients), and other combinations (139 patients). Eighty-five patients (18%) received preoperative radiation. Operations were pneumonectomy (97 patients), lobectomy (297 patients), lesser resection (18 patients), and exploration only (58 patients). Total mortality was 7 of 297 (2.4%) and 11 of 97 (11.3%) for all lobectomies and pneumonectomies, respectively, but mortality was 11 of 46 (23.9%) for right pneumonectomy. Complications developed in 179 patients (38%). By multiple regression analysis, right pneumonectomy (p=0.02), blood loss (p=0.01), and forced expiratory volume in one second (percent predicted) (p=0.01) predicted complications. No factor emerged to explain this high right pneumonectomy mortality rate. Conclusions. Pulmonary resection after neoadjuvant therapy is associated with acceptable overall morbidity and mortality. However, right pneumonectomy is associated with a significantly increased risk and should be performed only in selected patients. © 2001 by The Society of Thoracic Surgeons.
Keywords: adult; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; surgical technique; major clinical study; cisplatin; paclitaxel; cancer radiotherapy; combined modality therapy; neoadjuvant therapy; neoplasm staging; carboplatin; lung non small cell cancer; lung resection; thoracotomy; carcinoma, non-small-cell lung; lung neoplasms; pneumonectomy; morbidity; risk factor; vinblastine; risk assessment; risk; postoperative complication; postoperative complications; adjuvant chemotherapy; surgical mortality; mitomycin; postoperative hemorrhage; lobectomy; hospital mortality; humans; human; male; female; priority journal; article; forced expiratory flow
Journal Title: Annals of Thoracic Surgery
Volume: 72
Issue: 4
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2001-10-01
Start Page: 1149
End Page: 1154
Language: English
DOI: 10.1016/s0003-4975(01)02995-2
PUBMED: 11603428
PROVIDER: scopus
Notes: Presented at the 37th Annual Meeting of The Society of Thoracic Surgeons; 2001 Jan 29-31; New Orleans, LA -- Export Date: 21 May 2015 -- Source: Scopus
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MSK Authors
  1. Venkatraman Ennapadam Seshan
    296 Seshan
  2. Robert J Korst
    26 Korst
  3. Valerie W Rusch
    677 Rusch
  4. Robert J Ginsberg
    147 Ginsberg
  5. Tracey Weigel
    11 Weigel
  6. Jocelyne Martin
    5 Martin
  7. Robert J Downey
    208 Downey
  8. Manjit S Bains
    233 Bains
  9. Mark Kris
    636 Kris