The effect of neoadjuvant chemotherapy on complications in patients undergoing surgical treatment for non small cell lung cancer.

Neoadjuvant chemotherapy before resection is being the standard of care for stage IIIA non-small cell lung cancer in many institutions. The risk of complications in patients undergoing thoracotomy after induction chemotherapy remain controversial. We reviewed our experience. From 1998 to 2003, 29 patients underwent pulmonary resection after induction chemotherapy for advanced non-small cell lung cancer. Pneumonectomies were performed for 16 (55,2%) patients (2 right sleeve pneumonectomy and 1 pneumonectomy with wedge excision of tracheal carina), lobectomies for 11 (37,9%) patients (3 right upper sleeve lobectomy), segmentectomies for 1 (3,45%) patient and explorative thoracotomy for 1 (3,45%) patient. There were 3 (10,3%) postoperative deaths, all after right pneumonectomy; 2 caused by pneumonia of the left lung, 1 caused by pulmonary embolism in patient after rethoracotmy for hemothorax. The postoperative complications included pneumonia in 2 patients, postoperative bleeding in 2, hemothorax in 1, prolonged intubation in 1, vocal cord paralysis in 2, cardiac arrhythmia in 2, atelectasis in 1 and residual air space in 1, resulting in 41,4% morbidity. Most of complications occured after right pneumonectomy (45,5%). The mortality of patients who had received induction chemotherapy was higher than that of a comparative group of 1529 who underwent lung resection or only exploration without induction chemotherapy during the same period, and the difference was significant(10,3% vs 4,1%; p=0,01). Morbidity differences were not significant(p=0,94). Pneumonol. Alergol. Pol. 2004, 72, 477:481