Galetta D, Spaggiari L.
Early and Long-Term Results of Tracheal Sleeve Pneumonectomy for Lung Cancer After Induction Therapy.
Ann Thorac Surg. 2017 Dec 22. pii: S0003-4975(17)31630-2. doi: 10.1016/j.athoracsur.2017.11.052. [Epub ahead of print]
The role of induction therapy (IT) and its effects on morbidity and mortality of patients receiving tracheal sleeve pneumonectomy (TSP) are unclear. We evaluated early and long-term outcomes of patients who underwent TSP after IT.
From 1998 to 2015, 32 patients (26 men; median age, 63 years) underwent TSP. Twenty-two patients (69%) received IT (cisplatin based chemotherapy). TSPs were all right sided and included 3 completion pneumonectomies. Superior vena cava resection was combined with TSP in 15 cases. Diaphragmatic and vertebral resection was also associated in one case each.
Operative mortality was nil. Thirty-day mortality was 9% (n=3). Major complications occurred in 7 patients (21.8%): 3 broncho-pleural fistulas, 2 ARDS, 1 cardiac hernia, and 1 empyema. IT had no significant effects on morbidity and mortality. Resection was complete in 31 patients (97%). Pathological N status was N0 in two cases, N1 in 17, and N2 in 13. Nodal downstaging was diagnosed in 13/22 (59.1%) patients who received IT (11 passed from N2 to N1, and 2 to N0). Mean survival was 36 months (range, 1 to 181 months). Overall 5-year survival and disease free survival were 30.3% and 27.7%, respectively. Patients receiving IT had a poor survival (p=.03). At multivariate analysis, nodal downstaging and adjuvant treatment, significantly affected survival (p=.035 and p=.007, respectively).
TSP is a feasible but technically challenging surgical procedure and provides acceptable results in terms of early and long-term outcomes. IT did not significantly affect morbidity and mortality.