Skip to main content
Erschienen in: General Thoracic and Cardiovascular Surgery 11/2018

06.08.2018 | Original Article

Surgical outcomes and complications of pneumonectomy after induction therapy for non-small cell lung cancer

verfasst von: Hidenao Kayawake, Norihito Okumura, Keiji Yamanashi, Yasuhiro Otsuki, Ayuko Takahashi, Satoshi Itasaka, Hiroshige Yoshioka, Takashi Nakashima, Tomoaki Matsuoka

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 11/2018

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Although surgical resection after induction therapy (IT) for locally advanced non-small cell lung cancer (NSCLC) is a possible treatment option, pneumonectomy may be avoided owing to high-surgical risks. However, reports exist that pneumonectomy after IT has acceptable safety and favorable outcomes. We reviewed pneumonectomies after IT in terms of surgical outcomes, perioperative management, and complications.

Methods

Between April 2004 and March 2015, 15 consecutive pneumonectomies were performed for locally advanced NSCLC after IT. Surgical outcomes, perioperative management, and complications were retrospectively reviewed.

Results

Thirteen patients were men, and 6 pneumonectomies were right-sided. One pneumonectomy was performed after induction chemotherapy and 14 followed induction chemoradiation. In all 15 cases the bronchial stumps were covered with autologous tissues. Pedunculated mediastinal fat pad and pedunculated intercostal muscles were used in 4 and 11 cases, respectively. Although postoperative complications were seen in 12 patients (80.0%), with major complications (Clavien–Dindo classification ≥ IIIa) in 5 patients (33.3%), there were no deaths within 30 days after pneumonectomy. Overall 3- and 5-year survivals were 80.0 and 57.1%, respectively.

Conclusions

Owing to high-surgical risks and complication rates, careful surgical technique and postoperative management are essential for successful pneumonectomy after IT.
Literatur
1.
Zurück zum Zitat Albain KS, Swann RS, Rusch VW, Turrisi IIIAT, Shepherd FA, Smith C, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374:379–86.CrossRef Albain KS, Swann RS, Rusch VW, Turrisi IIIAT, Shepherd FA, Smith C, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374:379–86.CrossRef
2.
Zurück zum Zitat Venuta F, Anile M, Diso D, Ibrahim M, De Giacomo T, Rolla M, et al. Operative complications and early mortality after induction therapy for lung cancer. Eur J Cardiothorac Surg. 2007;31:714–8.CrossRef Venuta F, Anile M, Diso D, Ibrahim M, De Giacomo T, Rolla M, et al. Operative complications and early mortality after induction therapy for lung cancer. Eur J Cardiothorac Surg. 2007;31:714–8.CrossRef
3.
Zurück zum Zitat Koshy M, Fedewa SA, Malik R, Ferguson MK, Vigneswaran MT, Feldman L, et al. Improved survival associated with neoadjuvant chemoradiation in patients with clinical stage IIIA(N2) non–small-cell lung cancer. J Thorac Oncol. 2013;8:915–22.CrossRef Koshy M, Fedewa SA, Malik R, Ferguson MK, Vigneswaran MT, Feldman L, et al. Improved survival associated with neoadjuvant chemoradiation in patients with clinical stage IIIA(N2) non–small-cell lung cancer. J Thorac Oncol. 2013;8:915–22.CrossRef
4.
Zurück zum Zitat Pless M, Stupp R, Ris HB, Stahel RA, Weder W, Thierstein S, et al. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet. 2015;386:1049–56.CrossRef Pless M, Stupp R, Ris HB, Stahel RA, Weder W, Thierstein S, et al. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet. 2015;386:1049–56.CrossRef
5.
Zurück zum Zitat Weder W, Collaud S, Eberhardt WEE, Hillinger S, Welter S, Stahel R, et al. Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2010;139:1424–30.CrossRef Weder W, Collaud S, Eberhardt WEE, Hillinger S, Welter S, Stahel R, et al. Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2010;139:1424–30.CrossRef
6.
Zurück zum Zitat Doddoli C, Barlesi F, Trousse D, Robitail S, Yena S, Astoul O, et al. One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: an uncertain balance between risks and benefits. J Thorac Cardiovasc Surg. 2005;130:416–25.CrossRef Doddoli C, Barlesi F, Trousse D, Robitail S, Yena S, Astoul O, et al. One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: an uncertain balance between risks and benefits. J Thorac Cardiovasc Surg. 2005;130:416–25.CrossRef
7.
Zurück zum Zitat Broderick SR, Patel AP, Crabtree TD, Bell JM, Morgansztern D, Robinson CG, et al. Pneumonectomy for clinical stage IIIA non-small cell lung cancer: the effect of neoadjuvant therapy. Ann Thorac Surg. 2016;101:451–8.CrossRef Broderick SR, Patel AP, Crabtree TD, Bell JM, Morgansztern D, Robinson CG, et al. Pneumonectomy for clinical stage IIIA non-small cell lung cancer: the effect of neoadjuvant therapy. Ann Thorac Surg. 2016;101:451–8.CrossRef
8.
Zurück zum Zitat d’Amato TA, Ashrafi AS, Schuchert MJ, Alshehab DSA, Seely AJ, Shamji FM, et al. Risk of pneumonectomy after induction therapy for locally advanced non-small cell lung cancer. Ann Thorac Surg. 2009;88:1079–85.CrossRef d’Amato TA, Ashrafi AS, Schuchert MJ, Alshehab DSA, Seely AJ, Shamji FM, et al. Risk of pneumonectomy after induction therapy for locally advanced non-small cell lung cancer. Ann Thorac Surg. 2009;88:1079–85.CrossRef
9.
Zurück zum Zitat Kim AW, Faber LP, Warren WH, Basu S, Wightman SC, Weber JA, et al. Pneumonectomy after chemoradiation therapy for non-small cell lung cancer: does “side” really matter? Ann Thorac Surg. 2009;88:937–44.CrossRef Kim AW, Faber LP, Warren WH, Basu S, Wightman SC, Weber JA, et al. Pneumonectomy after chemoradiation therapy for non-small cell lung cancer: does “side” really matter? Ann Thorac Surg. 2009;88:937–44.CrossRef
10.
Zurück zum Zitat Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC lung cancer staging project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2:706–14.CrossRef Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC lung cancer staging project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2:706–14.CrossRef
11.
Zurück zum Zitat Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRef Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRef
12.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRef
13.
Zurück zum Zitat Clavien PA, Barkun J, de Oliverla ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRef Clavien PA, Barkun J, de Oliverla ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRef
14.
Zurück zum Zitat Kim AW, Liptay MJ, Bonomi P, Warren WH, Basu S, Farlow EC, et al. Neoadjuvant chemoradiation for clinically advanced non-small cell lung cancer: an analysis of 233 patients. Ann Thorac Surg. 2011;92:233–43.CrossRef Kim AW, Liptay MJ, Bonomi P, Warren WH, Basu S, Farlow EC, et al. Neoadjuvant chemoradiation for clinically advanced non-small cell lung cancer: an analysis of 233 patients. Ann Thorac Surg. 2011;92:233–43.CrossRef
15.
Zurück zum Zitat Speicher PJ, Englum BR, Ganapathi AM, Onaitis MW, D’Amico TA, Berry MF. Outcomes after treatment of 17 378 patients with locally advanced (T3N0–2) non-small-cell lung cancer. Eur J Cardiothorac Surg. 2015;47:636–41.CrossRef Speicher PJ, Englum BR, Ganapathi AM, Onaitis MW, D’Amico TA, Berry MF. Outcomes after treatment of 17 378 patients with locally advanced (T3N0–2) non-small-cell lung cancer. Eur J Cardiothorac Surg. 2015;47:636–41.CrossRef
16.
Zurück zum Zitat Katakami N, Tada H, Mitsudomi T, Kudoh S, Senba H, Matsui K, et al. A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903). Cancer. 2012;118:6126–35.CrossRef Katakami N, Tada H, Mitsudomi T, Kudoh S, Senba H, Matsui K, et al. A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confirmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903). Cancer. 2012;118:6126–35.CrossRef
17.
Zurück zum Zitat Friedel G, Budach W, Dippon J, Spengler W, Echmann SM, Pfannenberg C, et al. Phase II trial of a trimodality regimen for stage III non-small-cell lung cancer using chemotherapy as induction treatment with concurrent hyperfractionated chemoradiation with carboplatin and paclitaxel followed by subsequent resection: a single-center study. J Clin Oncol. 2010;28:942–8.CrossRef Friedel G, Budach W, Dippon J, Spengler W, Echmann SM, Pfannenberg C, et al. Phase II trial of a trimodality regimen for stage III non-small-cell lung cancer using chemotherapy as induction treatment with concurrent hyperfractionated chemoradiation with carboplatin and paclitaxel followed by subsequent resection: a single-center study. J Clin Oncol. 2010;28:942–8.CrossRef
18.
Zurück zum Zitat Steger V, Spengler W, Hetzel J, Veit S, Walker T, Mustafi M, et al. Pneumonectomy: calculable or non-tolerable risk factor in trimodal therapy for stage III non-small-cell lung cancer? Eur J Cardiothorac Surg. 2012;41:880–5.CrossRef Steger V, Spengler W, Hetzel J, Veit S, Walker T, Mustafi M, et al. Pneumonectomy: calculable or non-tolerable risk factor in trimodal therapy for stage III non-small-cell lung cancer? Eur J Cardiothorac Surg. 2012;41:880–5.CrossRef
19.
Zurück zum Zitat Allen AM, Mentzer SJ, Yeap BY, Soto R, Baldini EH, Rabin MS, et al. Pneumonectomy after chemoradiation; the Dana-Farber Cancer Institute/Brigham and Women’s Hospital experience. Cancer. 2008;112:1106–13.CrossRef Allen AM, Mentzer SJ, Yeap BY, Soto R, Baldini EH, Rabin MS, et al. Pneumonectomy after chemoradiation; the Dana-Farber Cancer Institute/Brigham and Women’s Hospital experience. Cancer. 2008;112:1106–13.CrossRef
20.
Zurück zum Zitat Chen F, Okubo K, Sonobe M, Shibuya K, Matsuo Y, Kim YH, et al. Hyperfractionated irradiation with 3 cycles of induction chemotherapy in stage IIIA-N2 lung cancer. World J Surg. 2012;36:2858–64.CrossRef Chen F, Okubo K, Sonobe M, Shibuya K, Matsuo Y, Kim YH, et al. Hyperfractionated irradiation with 3 cycles of induction chemotherapy in stage IIIA-N2 lung cancer. World J Surg. 2012;36:2858–64.CrossRef
21.
Zurück zum Zitat Toyooka S, Kiura K, Shien K, Katsui K, Hotta K, Kanazawa S, et al. Induction chemoradiotherapy is superior to induction chemotherapy for the survival of non-small-cell lung cancer patients with pathological mediastinal lymph node metastasis. Interact Cardiovasc Thorac Surg. 2012;15:954–60.CrossRef Toyooka S, Kiura K, Shien K, Katsui K, Hotta K, Kanazawa S, et al. Induction chemoradiotherapy is superior to induction chemotherapy for the survival of non-small-cell lung cancer patients with pathological mediastinal lymph node metastasis. Interact Cardiovasc Thorac Surg. 2012;15:954–60.CrossRef
22.
Zurück zum Zitat Fujita S, Katakami N, Takahashi Y, Hirokawa K, Ikeda A, Tabata C, et al. Postoperative complications after induction chemoradiotherapy in patients with non-small-cell lung cancer. Eur J Cardiothorac Surg. 2006;29:896–901.CrossRef Fujita S, Katakami N, Takahashi Y, Hirokawa K, Ikeda A, Tabata C, et al. Postoperative complications after induction chemoradiotherapy in patients with non-small-cell lung cancer. Eur J Cardiothorac Surg. 2006;29:896–901.CrossRef
Metadaten
Titel
Surgical outcomes and complications of pneumonectomy after induction therapy for non-small cell lung cancer
verfasst von
Hidenao Kayawake
Norihito Okumura
Keiji Yamanashi
Yasuhiro Otsuki
Ayuko Takahashi
Satoshi Itasaka
Hiroshige Yoshioka
Takashi Nakashima
Tomoaki Matsuoka
Publikationsdatum
06.08.2018
Verlag
Springer Japan
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 11/2018
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-018-0980-4

Weitere Artikel der Ausgabe 11/2018

General Thoracic and Cardiovascular Surgery 11/2018 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.