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  • Title: The incidence of perioperative anastomotic complications after sleeve lobectomy is not increased after neoadjuvant chemoradiotherapy.
    Author: Milman S, Kim AW, Warren WH, Liptay MJ, Miller C, Basu S, Faber LP.
    Journal: Ann Thorac Surg; 2009 Sep; 88(3):945-50; discussion 950-1. PubMed ID: 19699925.
    Abstract:
    BACKGROUND: Concurrent neoadjuvant chemoradiotherapy can potentially impact on the results of sleeve lobectomy. The purpose of this study was to examine this effect in terms of morbidity, mortality, and long-term survival in patients with non-small cell lung cancer. METHODS: Clinical records of patients with non-small cell lung cancer undergoing sleeve lobectomy between 1983 and 2008 were reviewed for age, sex, type of sleeve resection, clinicopathologic TNM stage, complications, and 90-day mortality. Chemotherapy and radiation therapy regimens were recorded for the patients undergoing neoadjuvant treatment. Kaplan-Meier survival curves were compared. RESULTS: There were 64 patients identified as having undergone sleeve resection for non-small cell lung cancer. Of the 64 total patients, 43 did not receive concurrent neoadjuvant chemoradiotherapy [NCR] versus 21 patients who did [CRS]. All of the CRS patients underwent platinum-based chemotherapy and radiation (range, 2,000 to 6,100 cGy). Thirteen patients (62%) were downstaged, with 4 complete responders. The 90-day mortality was 2.7% (2 patients) in the NCR group and 0% in the CRS group. The incidence of major complications in the NCR group was 46.5% (20 of 43) with 4.7% (2 of 43) anastomosis-related complications (stenosis, 1; bronchovascular fistula, 1). The incidence of major complications in the CRS group was 42.9% (9 of 21) with no anastomosis-related problems. Five-year survival in the NCR group was 48% compared with 41% in the CRS group (p = 0.63). There were 9% (4 of 43) of patients with local recurrence in the NCR group versus 10% (2 of 21) of patients in the CRS group (p = 0.65). CONCLUSIONS: Anastomosis-related complications were not increased among the patients receiving neoadjuvant therapy compared with those who did not. In addition, local recurrence was also similar between the two groups. Furthermore, the survival of the two groups was not statistically different. Sleeve lobectomy after chemoradiotherapy for advanced non-small cell lung cancer can be performed with acceptable morbidity and mortality.
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