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Paolo Macchiarini
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Ann Thorac Surg 1994;57:966-973
© 1994 The Society of Thoracic Surgeons

Articles

Extended operations after induction therapy for stage IIIb (T4) non-small cell lung cancer

Paolo Macchiarini, MD*, Alain R. Chapelier, MD, Isabelle Monnet, MD, Jean-Michel Vannetzel, MD, Jean-Louis Rebischung, MD, Jacques Cerrina, MD, François Parquin, MD, François Le Roy Ladurie, MD, Bernard Lenot, MD, Philippe G. Dartevelle, MD

Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France

Accepted for publication August 5, 1993.

* Address reprint requests to Dr Macchiarini, Department of Thotacic and Vascular Surgery and Heart-Lung Transplantation, Hopital Marie-Lannelongue, Paris-Sud University, 133 Ave de la Resistance, 92350 Plessis Robinson, France.

Twenty-three patients with stage IIIb (T4) non-small cell lung cancer received induction chemotherapy (median, 2 cycles) with (n = 12) or without (n = 11) radiation (median, 45 Gy) before operation. Nine tumors involved the carina (n = 8) or lateral trachéal wall (n = 1), 11 were located centrally and invaded the proximal pulmonary artery (n = 6), veins (n = 3), or both (n = 2), three were apical tumors involving T4 structures, and six were associated with historically diseased mediastinal nodes. Five complete and 18 partial responses were observed after induction treatment. Resection of all residual tumor at the primary site and involved vestiges was possible in 21 patients (91%); in two apical tumors, tumor was left behind. Nine right tracheal sleeve and 11 intrapericardial pneumonectomies and three resections of apical rumors were performed; 11 patients (48%) had radical mediastinal lymph node dissection. Complete sterilization of the primary tumor was observed in 3 patients (13%). Mean operating time was 209.3 ± 86.8 minutes, and mean blood loss was 896.9 ± 1031 mL. Major postoperative complications occurred in 6 patients (26%), including hemothorax requiring drainage (n = 1) or reoperation (n = 1), acute distress syndrome (n = 2), and bronchopleural fistula (n = 2), and their incidence was significantly higher (p = 0.003) among patients receiving induction chemoradiation than among those receiving chemotherapy alone (42 versus 9%). Early (<1 month) postt oerative mortality was 8.6% (n = 2). With a median follow-up of 25 months (range, 12 to more than 39 months), the projected 3-year overall survival was 54%. Further follow-up will define whether this aggressive approach should become standard care for selected IIIb (T4) non-small cell lung cancer patients.




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