Document Detail


Does induction treatment increase the risk of morbidity and mortality after pneumonectomy? A multicentre case-matched analysis.
MedLine Citation:
PMID:  19836257     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The objective of this investigation was to compare postoperative morbidity and early and late mortality in patients after pneumonectomy for non-small-cell lung cancer (NSCLC) with or without induction neo-adjuvant therapy.
METHODS: This is an observational study performed on prospectively collected data at four tertiary referral centres (2000-2007). Of 225 pneumonectomies for NSCLC, 81 patients underwent neo-adjuvant chemotherapy. Several perioperative variables were used in identifying propensity score-matched pairs of patients with and without induction treatment. The matched groups were then compared in terms of morbidity, early (30-day or in-hospital) and 90-day mortality.
RESULTS: The overall cardiopulmonary morbidity, early mortality and 90-day mortality rates were 30% (67 patients), 7.1% (16 patients) and 9.8% (22 patients), respectively. Propensity score analysis yielded 56 well-matched pairs of patients with and without induction chemotherapy. The two groups had similar early and late mortality rates: four versus four (p=1) and seven versus seven (p=1), respectively. Moreover, the incidence of cardiopulmonary morbidity and bronchopleural fistula were also similar in both the groups: 19 versus 17 patients (Fisher's exact test p=0.7) and two versus three patients (Fisher's exact test, p=0.7), respectively. Twenty-one patients with induction chemo-radiotherapy were analysed separately and compared with well-matched counterparts without any induction treatment. No significant differences were identified in terms of early mortality (1 vs 0, p=1), 90-day mortality (1 vs 0, p=1), cardiopulmonary complications (5 vs 5, p=1) and bronchopleural fistula (1 vs 1, p=1).
CONCLUSIONS: Current regimens of induction treatment do not seem to increase the risk of morbidity, early mortality and late mortality after pneumonectomy in properly selected patients. This study warrants confirmation from future multicentre prospective randomised trials powered on early outcomes.
Authors:
Majed Refai; Alessandro Brunelli; Gaetano Rocco; Mark K Ferguson; Sergio N Fortiparri; Michele Salati; Antonello La Rocca; Kenji Kawamukai
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  37     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2011-01-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  535-9     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. All rights reserved.
Affiliation:
Umberto I Regional Hospital Ancona, Ancona, Italy. majedit@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Antineoplastic Agents / adverse effects
Carcinoma, Non-Small-Cell Lung / drug therapy*,  radiotherapy,  surgery
Chemotherapy, Adjuvant / adverse effects
Epidemiologic Methods
Female
Forced Expiratory Volume
Humans
Lung Neoplasms / drug therapy*,  radiotherapy,  surgery
Male
Middle Aged
Neoadjuvant Therapy / adverse effects*
Pneumonectomy / adverse effects*
Pulmonary Diffusing Capacity
Radiotherapy, Adjuvant / adverse effects
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antineoplastic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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