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Ann Thorac Surg 1993;55:986-989
© 1993 The Society of Thoracic Surgeons

Articles

Postoperative complications after combined neoadjuvant treatment of lung cancer

Wyatt C. Fowler, MDa,b,c, Corey J. Langer, MDa,b,c, Walter J. Curran, Jr, MDa,b,c, Steven M. Keller, MD*,a,b,c

a Departments of Surgical Oncology, Medical Oncology, and Radiation Oncology, Fox Chase Cancer Center USA
b Temple University School of Medicine USA
c University of Pennsylvania, Philadelphia, Pennsylvania USA

Accepted for publication September 30, 1992.

* Address reprint requests to Dr Keller, Department of Cardiothoracic Surgery. The Mount Sinai Medical Center, 1 Gustave Levy Place, New-York, NY 10029.

Preoperative chemotherapy and radiation administered separately or in combination have been used in the treatment of locally advanced non-small cell lung cancer. To assess the postoperative morbidity and mortality associated with aggressive neoadjuvant therapy, we reviewed the records of 13 patients who underwent resection of locally advanced non-small cell lung cancer after two monthly cycles of infusional 5-fluorouracil, 640 to 800 mg/m2 (days 1 through 5); cisplatin, 20 mg/m2 (days 1 through 5); eloposide, 50 mg/m2 (days 1, 3, and 5); and concomitant radical thoracic irradiation (6,000 cGy) administered in 200-cGy daily fractions. Six patients underwent lobectomy with no mortality, whereas 7 pneumonectomies were associated with three deaths (43%). Culture-negative, diffuse pulmonary infiltrates developed 3 to 6 days after operation in 5 of 7 pneumonectomy patients and in 1 of 6 lobectomy patients. Two patients who had undergone pneumonectomy died of progressive adult respiratory distress syndrome. A third death resulted from a bronchopleural fistula that developed 30 days after pneumonectomy. Morbidity and mortality were not associated with preoperative pulmonary function test results, nutritional status, or intraoperative inspired oxygen fraction (p > 0.05 by {chi} 2 test). Only pneumonectomy correlated with increased morbidity and mortality (p < 0.05 by {chi} 2 test). We conclude that lobectomy may be performed safely after this combination of aggressive chemotherapy and high-dose radiation, but pneumonectomy is associated with unacceptable morbidity and mortality.




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