Impact of Neoadjuvant Chemoradiation On Adverse Events Following Bronchial Sleeve Resection

Abstract Background We analyzed the association between neoadjuvant chemoradiation in patients undergoing bronchial sleeve resection with incidence of postoperative pulmonary and airway complications. Methods After IRB approval, we performed a retrospective review of a prospectively maintained database of 136 patients who underwent sleeve resection in our institution between January 1998 and December 2016. Administration of neoadjuvant chemoradiation treatment was the studied exposure. Outcomes of interest were rates of postoperative pulmonary and airway complications. Nonparametric testing of demographic, surgical, pathologic characteristics and morbidity was performed. Logistic regression models evaluated postoperative pulmonary complications and airway complications. Analysis was performed using Stata/IC 15. Results We analyzed 136 patients (18 underwent neoadjuvant chemoradiation). 77 of the 136 patients (57%) had Non-Small-Cell Lung Cancer. Postoperative pulmonary complications were observed in 44/136 patients (32%). Incidence of pulmonary complications were higher in the neoadjuvant chemoradiation group compared to those without neoadjuvant radiation [15/18 patients (83%) vs. 29/118 patients (25%), p=0.000]. Likewise, rates of pneumonia, atelectasis, respiratory insufficiency, bronchial stenosis, prolonged air leak, broncho-pleural fistula and completion pneumonectomy [2/18 (11%)] were higher in the neoadjuvant chemoradiation group, reaching statistical significance in all cases except bronchial stenosis and prolonged air leak. Only neoadjuvant chemoradiation therapy remained significant for postoperative pulmonary and airway complications on logistic regression (both p Conclusions Patients who undergo neoadjuvant chemoradiation prior to sleeve resection are at an increased risk of pulmonary and airway complications.