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J Thorac Cardiovasc Surg 2003;126:1670-1671
© 2003 The American Association for Thoracic Surgery

Letters to the editor

Safety of bronchoplastic resection after induction therapy for lung cancer

G. Veronesi, MDa, M. E. Leona, L. Spaggiari, MD, PhDa

a Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy

To the Editor:

We read with interest the article by Ohta and colleagues1 concerning the impact of induction treatment on patients who underwent full sleeve resection. Ohta and colleagues1 concluded that preoperative therapy did not significantly affect postoperative outcome. The issue of the impact of the neoadjuvant chemotherapy in patients with lung cancer is today an object of debate. It has been demonstrated that right pneumonectomy after induction treatment is associated with a high risk of postoperative complications,2 and Rendina and colleagues3 showed that lung-sparing resection could reduce the rate of pneumonectomy and could provide an alternative to a pneumonectomy after induction treatment.

We published in 2002 our experience with 27 patients who underwent induction treatment before lung-sparing resection.4 We had similar results, demonstrating that chemotherapy or chemoradiotherapy before surgery did not influence postoperative outcome. In addition, in our experience postoperative radiotherapy done for patients with N2 disease did not influence bronchial anastomosis in terms of late complications. Finally, the completeness of resection after lung-sparing resection in term of extension of mediastinal and hilar lymph node dissection was comparable to that obtained after pneumonectomy. At present, our experience with lung-sparing technique for lung cancer after induction treatment consists of 58 patients operated on through a period of 5 years, and it represent 54% of all sleeve resections performed during the same period (n = 106). A vascular resection was associated in 35% of cases. The overall postoperative morbidity rate and mortality of patients who underwent sleeve resection were 34% and 4.7%, respectively. Table 1 reports the comparison between the two groups (induction treatment vs no treatment).


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  		TABLE 1. Comparison of postoperative morbidity and mortality in patients undergoing bronchial sleeve resection (induction treatment versus no treatment)

 
This recent updated experience confirms our previous results and strongly supports the result of the article of Ohta and colleagues.1 Bronchoplastic resection after induction chemotherapy is a safe treatment for locally advanced lung cancer, and it should be done whenever it is possible instead of pneumonectomy.

References

  1. Ohta M, Sawabata N, Maeda H, Matsuda H. Efficacy and safety of tracheobronchoplasty after induction therapy for locally advanced lung cancer. J Thorac Cardiovasc Surg. 2003;125:96–100[Abstract/Free Full Text]
  2. Martin J, Ginsberg RJ, Abolhoda A, Bains M, Downey RJ, Korst RJ, et al. Morbidity and mortality after neoadjuvant therapy for lung cancer: the risks of right pneumonectomy. Ann Thorac Surg. 2001;72:1149–1154[Abstract/Free Full Text]
  3. Rendina EA, Venuta F, De Giacomo T, Flaishman I, Fazi P, Ricci C. Safety and efficacy of bronchovascular reconstruction after induction chemotherapy for lung cancer. J Thorac Cardiovasc Surg. 1997;114:830–837[Abstract/Free Full Text]
  4. Veronesi G, Solli PG, Leo F, D'Aiuto M, Pelosi G, Leon ME, et al. Low morbidity of bronchoplastic procedures after chemotherapy for lung cancer. Lung Cancer. 2002;36:91–97[Medline]

Related Article

Reply to the editor
Mitsunori Ohta, Noriyoshi Sawabata, Hajime Maeda, and Hikaru Matsuda
J. Thorac. Cardiovasc. Surg. 2003 126: 1671. [Extract] [Full Text] [PDF]




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