Postoperative complications of lung resection after induction chemotherapy using Paclitaxel (and radiotherapy) for advanced non small lung cancer

Background, Locally advanced non-small-cell lung carcinoma is currently treated by multidisciplinary protocols using a combination of chemotherapy, radiotherapy and surgery. However the best strategy for applying these therapeutic measures has not yet been established. One of the difficulties of using these forms of treatment is their toxicity. Our aim was to determine whether the postoperative course of the disease can be influenced by preoperative chemotherapy in any way. Methods. Nineteen patients were surgically treated after receiving induction treatment between October 1996 and October 1998. The indications for giving induction treatment were: stage M disease in 12 patients (1 Pancoast tumor), lung cancer and solitary brain metastasis in 4 patients, double primary lung cancer in 3 patients (1 synchronous and 2 metachronous). Variables were the chemotherapy treatment time interval from the beginning to surgery, the type of surgery, postoperative mortality and morbidity. Mean age was 55.9 years old (range between 25 and 70 years). Predominant gender was male (18 men and 1 woman). Neoadjuvant treatment consisted of chemotherapy in all patients (Paclitaxel, Cysplatin and Vinorelbine in cycles for a mean period of 3 months), and radiotherapy (14 patients). Pulmonary resections were: pneumonectomy (2 patients), lobectomy (16 patients) and wedge resection (I patient). There were no exploratory thoracotomies. Bronchoplasty procedures were necessary in 5 cases and angioplasty in 5. Cardiopulmonary bypass was necessary in 1 case in order to resect an infiltrated pulmonary vein. Intraoperative radiotherapy (IORT) was used in 9 cases. Results. Complications occurred in the immediate postoperative period in 9 patients: 1 postpneumonectomy respiratory distress syndrome, 2 bronchopleural fistulae, 4 prolonged air leaks, 1 complete dehiscence of the thoracotomy scar and 1 colitis caused by anaerobes. The postoperative mortality (within 30 days) was 2 patients (10.5%): 1 died from bronchopleural fistula and the other from postpneumonectomy respiratory distress syndrome. However, if we take into account the fact that the case of anaerobic colitis also ended with the patient's death on the 48th postoperative day, and we include it in the mortality rate, the final mortality is higher (15.8%). Conclusions. Surgery for non-small-cell lung carcinoma has to be considered a high-risk procedure. But, if patients are selected appropriately and the perioperative management is satisfactory, reasonable rates of morbidity and mortality can be achieved. More studies are needed in order to define the exact role of these therapeutic measures.