Surgical outcomes of pulmonary resection for lung cancer after neo-adjuvant treatment

• 作者: Arianna Barbetta Benedetto Mungo Cheryl K Zogg Craig M Hooker Daniela Molena Francisco Schlottmann
• 来源期刊: 世界外科手术杂志
• 学科: 医学
• 关键词: LUNG cancer Pulmonary RESECTION NEOADJUVANT therapy Surgical OUTCOMES
• 年，卷（期）: 2016,（2）
• 页码范围: 19-29
• 页数: 11页
• 分类号: R

摘要

AIM:To evaluate the outcomes of surgery for lung cancer after induction therapy.METHODS:Using the American College of Surgeons National Surgical Quality Improvement Program(ACSNSQIP)database(2005-2012),we identified 4063 patients who underwent a pulmonary resection for lung cancer.Two hundred and thirty-six(5.8%)received neo-adjuvant therapy prior to surgery(64 chemo-radiation,103 radiation alone,69 chemotherapy alone).The outcomes were compared to 3827 patients(94.2%)treated with surgery alone.Primary outcome was 30-d mortality,and secondary outcomes included length of stay,operative time and NSQIP measured postoperative complications.RESULTS:Lung cancer patients who received preoperative treatment were younger(66 vs 69,P<0.001),were more likely to have experienced recent weight loss(6.8%vs 3.5%;P=0.011),to be active smokers(48.3 vs 34.9,P<0.001),and had lower preoperative hematological cell counts(abnormal white blood cell:25.6 vs 13.4;P<0.001;low hematocrit 53%vs 17.3%,P<0.001).On unadjusted analysis,neo-adjuvant patients had significantly higher 30-d mortality,overall and serious morbidity(all P<0.001).Adjusted analysis showed similar findings,while matched cohorts comparison confirmed higher morbidity,but not higher early mortality.CONCLUSION:Our data suggest that patients who receive neo-adjuvant therapy for lung cancer have worse early surgical outcomes.Although NSQIP does not provide stage information,this analysis shows important findings that should be considered when selecting patients for induction treatment.