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Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database.

Abstract

OBJECTIVES

To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database.

METHODS

Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007-31 December 2017) (6587 pneumonectomies and 46 395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared.

RESULTS

8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44).

CONCLUSIONS

Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.

Authors+Show Affiliations

Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.Memorial Sloan Kettering Cancer Center, New York, NY, USA.University of Pecs, Pecs, Hungary.Aix-Marseille University & Hospitals System of Marseille, Marseille, France.University Hospital Strasbourg, Strasbourg, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31638692

Citation

Brunelli, Alessandro, et al. "Morbidity and Mortality of Lobectomy or Pneumonectomy After Neoadjuvant Treatment: an Analysis From the ESTS Database." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 2019.
Brunelli A, Rocco G, Szanto Z, et al. Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database. Eur J Cardiothorac Surg. 2019.
Brunelli, A., Rocco, G., Szanto, Z., Thomas, P., & Falcoz, P. E. (2019). Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, doi:10.1093/ejcts/ezz287.
Brunelli A, et al. Morbidity and Mortality of Lobectomy or Pneumonectomy After Neoadjuvant Treatment: an Analysis From the ESTS Database. Eur J Cardiothorac Surg. 2019 Oct 22; PubMed PMID: 31638692.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database. AU - Brunelli,Alessandro, AU - Rocco,Gaetano, AU - Szanto,Zalan, AU - Thomas,Pascal, AU - Falcoz,Pierre Emmanuel, Y1 - 2019/10/22/ PY - 2019/06/18/received PY - 2019/09/18/revised PY - 2019/09/20/accepted PY - 2019/10/23/entrez PY - 2019/10/23/pubmed PY - 2019/10/23/medline KW - Bronchopleural fistula KW - Lobectomy KW - Mortality KW - Neoadjuvant chemotherapy KW - Non-small-cell lung cancer KW - Outcome KW - Pneumonectomy JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg N2 - OBJECTIVES: To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. METHODS: Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007-31 December 2017) (6587 pneumonectomies and 46 395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared. RESULTS: 8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44). CONCLUSIONS: Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/31638692/Morbidity_and_mortality_of_lobectomy_or_pneumonectomy_after_neoadjuvant_treatment:_an_analysis_from_the_ESTS_database L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezz287 DB - PRIME DP - Unbound Medicine ER -