Original articleGeneral thoracicChanges in Pulmonary Function Tests After Neoadjuvant Therapy Predict Postoperative Complications
Section snippets
Patients
This is a retrospective review of a prospective database of a single university-based general thoracic surgeon. Patients who were 19 years of age or older, had PFTs performed within 8 weeks of the start of neoadjuvant chemotherapy or chemoradiotherapy, had repeat PFTs after the completion of their medical therapy, and then underwent elective pulmonary resection were included in this study. The University of Alabama at Birmingham's institutional review board approved this study as well as the
Results
There were 404 patients who underwent elective pulmonary resection after induction chemotherapy or chemoradiotherapy by one general thoracic surgeon between January 1999 and June 2008. However, only 132 of these patients met the entry criteria for this study. The most common reason for exclusion was the lack of both pretherapy and posttherapy PFTs. Patient characteristics are shown in Table 2. The most common indication for the use of neoadjuvant chemoradiotherapy was N2 disease; the most
Comment
The decision to operate on a patient after he or she has received neoadjuvant chemotherapy or chemoradiotherapy is based on several factors that assess the risks compared with the benefits of surgery. The benefits of surgery are based on the oncologic advantage of undergoing pulmonary resection and removal of the mediastinal and hilar lymph nodes. The debates hinges on the patient's true pathologic stage before the induction of therapy. However, too often patients are only clinically staged,
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Performance Comparison of Pulmonary Risk Scoring Systems in Lung Resection
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2020, Surgical Oncology Clinics of North AmericaCitation Excerpt :A similar recent analysis from the National Cancer Database of more than 130,000 patients undergoing lung resection for lung cancer found an increased incidence of 30-day and 90-day mortality after neoadjuvant treatment.31 Neoadjuvant chemotherapy has been found to be associated with structural changes in the lung leading to decreased diffusion capacity, which in turn may predispose to development of postoperative respiratory complications.32–35 The evidence from the literature warrants a re-evaluation of the pulmonary function after completion of the chemotherapy treatment and before lung resection to evaluate possible changes, particularly in diffusion capacity.3,4
After neoadjuvant chemoradiation therapy, predicted pulmonary function may be reduced by 10%
2018, Journal of Thoracic and Cardiovascular SurgeryImpact of induction chemoradiotherapy on pulmonary function after lobectomy for lung cancer
2018, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Although the patients in the present study were treated with lobectomy not pneumonectomy, our data showed that compensatory lung growth also occurred after lobectomy on the contralateral lung, even after ICRT. The limitations of the present study are as follows: (1) we could only match the confounders, for which there is evidence of association with postoperative pulmonary function, for making a sufficient match balance, (2) of the potential confounders that were not used for matching, the tumor size and N-stage might directly affect the resected lobe function causing the difference of postoperative pulmonary function between the groups, but they could not be matched because of complete different treatment indications for tumor stage between the groups, (3) preoperative SPECT lung perfusion in the ICRT group was conducted only after ICRT but not before ICRT, which did not allow us to address the short-term effects of ICRT before surgery, (4) survival bias between the groups (ie, whereas 3 patients in the ICRT group [4%] suffered surgery-related death, only 1 in the non-ICRT group [0.6%] died), and (5) DLCO was not examined in the present study, which has been reported to be a more sensitive measure of lung injury by ICRT than PFT.6-8 Regarding the first issue, the sensitivity analysis showed consistent results for the potential confounders, which were excluded from the matching.