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Original Articles: General Thoracic

Induction Chemotherapy Before Sleeve Lobectomy for Lung Cancer: Immediate and Long-Term Results

^a Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris University, Paris, France
^b Cedre Surgical Center, Boisguillaume, France
^c Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, Argenteuil, France

Accepted for publication June 25, 2009.

^_* Address correspondence to Dr Riquet, service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, 20-40 rue Leblanc, Paris, 75015, France (Email: marc.riquet{at}egp.aphp.fr).

Background: Induction chemotherapy does not increase the morbidity and mortality rates of bronchoplastic procedures, but the long-term efficiency remains unclear. The purpose of this retrospective study was to analyze the impact of chemotherapy on resectability and long-term survival.

Methods: From 1984 to 2005, 159 consecutive patients with non–small cell lung cancer underwent sleeve lobectomy without (n = 117) or with induction chemotherapy (n = 42). Indications for chemotherapy were N2 lymph node involvement (n = 15), T3 or T4 tumor invasion with doubtful resectability (n = 13), need for tumor size reduction (n = 8), lung function precluding pneumonectomy (n = 4), and brain metastasis (n = 2). None of the patients received induction radiation therapy. We studied tumor characteristics and immediate and long-term results in both groups.

Results: Clinical stage III was predominant in the induction chemotherapy group whereas stage II was predominant in the surgery-only group. Complication rates in the induction chemotherapy group and in the surgery-only group were 23.8% and 24.7%, respectively. We observed a greater rate of 1-month-delay smoking cessation before surgery in the induction chemotherapy group (40% versus 22%). The 5-year survival rates were 65.4% in the surgery-only group and 73.4% in the induction chemotherapy group (p = 0.5). The tumor size in the induction chemotherapy group was lower (17.5 versus 30.6 mm; p = 0.01), which reflected the positive impact of chemotherapy on sleeve resection feasibility.

Conclusions: Induction chemotherapy before sleeve lobectomy achieves good long-term results. Tumor reduction and limited resection feasibility seemed to be increased, which justify further prospective trials.

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Invited Commentary

Hans Hoffmann
Ann. Thorac. Surg. 2009 88: 1736. [Extract] [Full Text] [PDF]

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