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01-05-2019 | NSCLC | Original Scientific Report

Does Induction Therapy Increase Anastomotic Complications in Bronchial Sleeve Resections?

Authors: Giovanni M. Comacchio, Marco Schiavon, Danila Azzolina, Marco Mammana, Giuseppe Marulli, Andrea Zuin, Enrico Verderi, Nicola Monaci, Laura Bonanno, Giulia Pasello, Federico Rea

Published in: World Journal of Surgery | Issue 5/2019

Abstract

Background

Sleeve lobectomy represents a safe and effective treatment for central NSCLC to avoid the risks of pneumonectomy. Induction therapy (IT) may be indicated in advanced stages; however, the effect of IT on bronchial anastomoses remains uncertain. The purpose of the study was to evaluate the impact of IT on the complications of the anastomoses.

Methods

Between 2000 and 2012, 159 consecutive patients were submitted to sleeve lobectomy for NSCLC at our Institution. We retrospectively compared the results of patients who underwent IT before operation with those who received upfront surgery.

Results

In the study period, 49 (30.8%) patients received IT (37 chemotherapy, 1 radiotherapy and 11 chemo-radiotherapy) and 110 (69.2%) patients were directly submitted to surgery (S). The two groups were comparable for sex, age, comorbidities, ASA score, pulmonary function, side, type of procedure and histology. Pathological stage was statistically higher for IT group (p = 0.001). No differences between IT and S groups were observed in terms of post-operative mortality (2% vs 0%, p = NS), morbidity (45% vs 38%, p = NS), including early (6% vs 9%, p = NS) and long-term (16% vs 14%, p = NS) bronchial complication rates. Patients undergoing induction mediastinal radiotherapy, however, are at higher risk of bronchial complications.

Conclusion

In our experience, the use of induction chemotherapy did not significantly increase mortality and morbidity rates, in particular, neither for early nor for late anastomotic complications. We, therefore, conclude that sleeve lobectomy after induction chemotherapy is safe and reliable procedure for the treatment of locally advanced NSCLC.

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Title: Does Induction Therapy Increase Anastomotic Complications in Bronchial Sleeve Resections?
Authors: Giovanni M. Comacchio
Marco Schiavon
Danila Azzolina
Marco Mammana
Giuseppe Marulli
Andrea Zuin
Enrico Verderi
Nicola Monaci
Laura Bonanno
Giulia Pasello
Federico Rea
Publication date: 01-05-2019
Publisher: Springer International Publishing
Keywords: NSCLC
NSCLC
Radiotherapy
Cytostatic Therapy
Pneumonectomy
Published in: World Journal of Surgery / Issue 5/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-019-04908-0

At a glance: The STEP trials

Springer Medicine

Does Induction Therapy Increase Anastomotic Complications in Bronchial Sleeve Resections?

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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