[Surgery of bronchial cancer after radiochemotherapy or chemotherapy. Risks and benefits]

The purpose of this study was to evaluate the conditions and results of lung cancer surgery, following chemo and/or radiotherapy. This retrospective study included 69 patients treated from January 1990 to January 1998 for a primary lung cancer in whom surgery had been performed after induction treatment. Surgery had not been considered initially for the following reasons: N2 disease (n = 25), temporary functional impairment (n = 4); doubtful resectability (n = 40). The medical regimen resulted in combined radio-chemotherapy in 43 patients who received 2 to 4 sessions of chemotherapy (average = 2.9 +/- 0.8 sessions) and 43 +/- 8 Gy (20 to 60 Gy), or chemotherapy alone in 26 patients (3 +/- 0.7 sessions). Exploratory thoracotomy was performed in 4 patients (6%). There were 33 pneumonectomies, 1 bilobectomy, 23 lobectomies and 8 lung sparing resections. The in-hospital mortality was 9% (n = 6) from respiratory origin in all cases. There were 4 reoperations (6%): 3 for bronchial fistula and 1 for bleeding. Thirty five patients (51%) required blood transfusion (4.5 +/- 3.8 cell packs). The incidence of early and delayed bronchial fistula after pneumonectomy was 15%. Thirteen patients had a postoperative pneumonia (19%). The overall 5 years survival was 22% [19-32]. In the group of patients who had a complete resection, five-years survival for patients classified pathologically as N0 or N1 was 31% and, for those classified as N2, 8% (p = 0.19). Surgical management after induction chemo and/or radiotherapy of NSC lung cancer should be considered, in the absence of N2 disease, when a complete resection is achievable. However this surgery is associated with an increased risk.