Does Induction Therapy Increase Anastomotic Complications in Bronchial Sleeve Resections?

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Sleeve lobectomy is a safe alternative to pneumonectomy for central non-small cell lung cancer (NSCLC).
• The safety of induction therapy (IT) prior to sleeve lobectomy concerning bronchial anastomoses is not well-established.
• IT is considered for advanced stages of NSCLC, but its impact on surgical complications requires evaluation.

Purpose of the Study:

• To assess the impact of induction therapy (IT) on bronchial anastomosis complications following sleeve lobectomy for NSCLC.
• To compare outcomes between patients receiving IT and those undergoing upfront surgery.

Main Methods:

• Retrospective analysis of 159 patients undergoing sleeve lobectomy for NSCLC between 2000 and 2012.
• Comparison of outcomes between patients who received IT (chemotherapy, radiotherapy, or chemo-radiotherapy) and those who had upfront surgery.
• Evaluation of post-operative mortality, morbidity, and specific bronchial complication rates.

Main Results:

• 49 patients (30.8%) received IT, while 110 (69.2%) had upfront surgery; groups were comparable in baseline characteristics.
• Pathological stage was significantly higher in the IT group (p=0.001).
• No significant differences in mortality, overall morbidity, or early/late bronchial complication rates were observed between IT and upfront surgery groups. However, induction mediastinal radiotherapy was associated with higher bronchial complication risk.

Conclusions:

• Induction chemotherapy prior to sleeve lobectomy does not significantly increase mortality or morbidity, including anastomotic complications.
• Sleeve lobectomy following induction chemotherapy is a safe and reliable procedure for treating locally advanced NSCLC.
• Induction mediastinal radiotherapy may increase the risk of bronchial complications.