Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non–small-cell lung cancer

Weder, Walter; Collaud, Stéphane; Eberhardt, Wilfried E.E.; Hillinger, Sven; Welter, Stefan; Stahel, Rolf; Stamatis, Georgios

doi:10.1016/j.jtcvs.2010.02.039

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1424-1430, June 2010

Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non–small-cell lung cancer

Walter Weder, MD
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
- Address for reprints: Walter Weder, MD, Head, Division of Thoracic Surgery, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich.
- Both authors contributed equally to this work.
Stéphane Collaud, MD
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
- Both authors contributed equally to this work.
Wilfried E.E. Eberhardt, MD
- Department of Internal Medicine, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
Sven Hillinger, MD
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
Stefan Welter, MD
- Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, Essen-Heidhausen, Germany
Rolf Stahel, MD
- Clinic and Policlinic of Oncology, University Hospital Zurich, Zurich, Switzerland
Georgios Stamatis, MD
- Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, Essen-Heidhausen, Germany

Received 13 May 2009; received in revised form 27 January 2010; accepted 20 February 2010. published online 26 April 2010.

Objective

The mortality of pneumonectomy after chemotherapy or chemoradiotherapy for locally advanced non–small-cell lung cancer is reported to be as high as 26%. We retrospectively reviewed the medical records of patients undergoing these procedures in 2 specialized thoracic centers to determine the outcome.

Methods

Retrospective analyses were performed of all patients who underwent pneumonectomy after neoadjuvant chemotherapy or chemoradiotherapy for locally advanced non–small-cell lung cancer from 1998 to 2007. Presurgical treatment consisted of 3-4 platin-based doublets alone in 20% of patients or combined with radiotherapy (45Gy) to the tumor and mediastinum in 80% of patients.

Results

Of 827 patients who underwent neoadjuvant therapy, 176 pneumonectomies were performed, including 138 (78%) extended resections. Post-induction pathologic stages were 0 in 36 patients (21%), I in 33 patients (19%), II in 38 patients (21%), III in 57 patients (32%), and IV in 12 patients (7%). Three patients died of pulmonary embolism, 2 patients of respiratory failure, and 1 patient of cardiac failure, resulting in a 90 postoperative day mortality rate of 3%; 23 major complications occurred in 22 patients (13%). For the overall population, 3-year survival was 43% and 5-year survival was 38%.

Conclusion

Pneumonectomy after neoadjuvant therapy for non–small-cell lung cancer can be performed with a perioperative mortality rate of 3%. Thus, the need of a pneumonectomy for complete resection alone should not be a reason to exclude patients from a potentially curative procedure if done in an experienced center. The 5-year survival of 38%, which can be achieved, justifies extended surgery within a multimodality concept for selected patients with locally advanced non–small-cell lung cancer.

CTSNet classification: 10

Abbreviations and Acronyms: ARDS, acute respiratory distress syndrome, BPF, bronchopleural fistula, CT, computed tomography, HR, hazard ratio, NSCLC, non–small-cell lung cancer, PET, positron emission tomography