Morbidity and Mortality after Major Pulmonary Resections in Patients with Locally Advanced Stage IIIA Non-small Cell Lung Carcinoma Who Underwent Induction Therapy

Peer, Michael; Stav, David; Cyjon, Arnold; Sandbank, Judith; Vasserman, Margarita; Haitov, Zoya; Sasson, Lior; Schreiber, Letizia; Ezri, Tiberiu; Priel, Israel E.; Hayat, Henri

doi:10.1016/j.hlc.2014.07.055

Cited by 9 publications

(10 citation statements)

References 24 publications

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“…In conclusion, either ICTx or ICTx + RT is a safe option in LN-positive NSCLC patients who are candidates for RAVTS lobectomy. This concurs with previous reports regarding morbidity and early mortality following postinduction thoracotomy and conventional VATS for NSCLC (3,18,19). These results lend support to the conclusions of multiple phase-III trials and meta-analyses that resection after induction therapy, particularly with lobectomy, can be safely performed so as to provide an OS benefit (1,3,4,11,12).…”

Section: Discussionsupporting

confidence: 91%

“…Evans et al also reported a higher rate of RLN injury following induction therapy, but did not report on rates of pulmonary embolism or of tracheal/bronchial injury (18). Overall, complications were seen at a rate within reasonable range of those reported in recent literature with thoracotomy and conventional VATS (3,18,19).…”

Section: Discussionsupporting

confidence: 69%

“…There was also a trend toward more patients with stable disease in the induction therapy group and increased upstaging in the surgery alone group, but neither gained significance (P=0.15 and P=0.13, respectively). Pathologic downstaging at reported rates of 39-45% with thoracotomy and conventional VATS has been associated with improved 5-year survival in stage-IIIA NSCLC (3,18,19). Therefore, a lower rate of downstaging may represent a poorer prognosis for some patients with LN-positive NSCLC after RAVTS lobectomy.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative outcomes and lymph node assessment after induction therapy in patients with clinical N1 or N2 non-small cell lung cancer

et al. 2016

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Induction CTx ± RT for cN1 or cN2 NSCLC patients did not affect EBL, operative times, or in-house mortality after RAVTS lobectomy. Patients undergoing RAVTS lobectomy after ICTx+ RT may be at greater risk for RLN injury, tracheal/bronchial injury, and pulmonary embolism. Fewer N2 LN stations, but not numbers of LNs, are assessed after ICTx ± RT. Induction therapy does not lead to increased downstaging.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Perioperative outcomes and lymph node assessment after induction therapy in patients with clinical N1 or N2 non-small cell lung cancer

et al. 2016

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“…Our finding that right-sided pneumonectomy is associated with worse perioperative mortality when compared with left-sided pneumonectomy is consistent with previous studies [3,4,[9][10][11][12][17][18][19][20][21][22][23][24]. In addition, we observed no significant differences in long-term survival between right-sided and left-sided pneumonectomy.…”

Section: Commentsupporting

confidence: 92%

Right-Sided Versus Left-Sided Pneumonectomy After Induction Therapy for Non-Small Cell Lung Cancer

Yang

Shah

Lin

et al. 2019

The Annals of Thoracic Surgery

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Background. A right-sided pneumonectomy after induction therapy for non-small cell lung cancer (NSCLC) has been shown to be associated with significant perioperative risk. We examined the effect of laterality on long-term survival after induction therapy and pneumonectomy using the National Cancer Data Base. Methods. Perioperative and long-term outcomes of patients who underwent pneumonectomy after induction chemotherapy, with or without radiotherapy, from 2004 to 2014 in the National Cancer Data Base were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Results. During the study period, 1,465 patients (right, 693 [47.3%]; left, 772 [52.7%]) met inclusion criteria. Right-sided pneumonectomy was associated with significantly higher 30-day (8.2% [57 of 693] vs 4.2% [32 of 772], p < 0.01) and 90-day mortality (13.6% [94 of 693] vs 7.9% [61 of 772], p < 0.01), and right-sided pneumonectomy was a predictor of higher 90-day mortality (odds ratio, 2.23; p < 0.01). However, overall 5-year survival between right and left pneumonectomy was not significantly different in unadjusted (37.6% [95% confidence interval {CI}, 0.34 to 0.42] vs 35% [95% CI, 0.32 to 0.39], log-rank p [ 0.94) or multivariable analysis (hazard ratio, 1.07; 95% CI, 0.92 to 1.25; p [ 0.40). A propensity score-matched analysis of 810 patients found no significant differences in 5-year survival between the right-sided versus left-sided groups (34.7% [95% CI, 0.30 to 0.40] vs 34.1%, [95% CI, 0.29 to 0.39], log-rank p [ 0.86). Conclusions. In this national analysis, right-sided pneumonectomy after induction therapy was associated with a significantly higher perioperative but not worse long-term mortality compared to a left-sided procedure.

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“…In a study on thoracic surgery (esophageal), Rice et al [64] noted a 34% risk of atrial arrhythmias in subjects receiving previous chemotherapy. Additionally, a significant incidence of PAF was reported in surgical lung cases after induction therapy [65]. Moreover, in this context, inflammation may potentially explain this phenomenon [66].…”

Section: Implications Of Chemotherapymentioning

confidence: 98%

Incidence, Management, Prevention and Outcome of Post-Operative Atrial Fibrillation in Thoracic Surgical Oncology

Fabiani

Colombo

Bacchiani

et al. 2019

JCM

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Atrial fibrillation (AF) is a common supraventricular arrhythmia, a recognized risk factor for ischemic stroke, as a potential driver for heart failure (HF). Cancer patients have an increased risk for AF, even not including any cancer-specific treatment, as surgery or chemotherapy. The mechanism is multifactorial, with inflammation and changes in autonomic tone as critical actors. Commonly, AF is a recurrent complication of the post-operative period in cancer surgery (especially thoracic). Recent papers confirmed a significant incidence of post-operative (non-cardiac surgery) AF (PAF), partially mitigated by the use of prophylactic (rate o rhythm control) treatments. A relevant difference, in terms of mean hospitalization time, emerges between patients developing PAF and those who do not, while long term impact remains a matter of debate, due to several potential confounding factors. Besides clinical predictors, structural (i.e., echocardiographic) and bio-humoral findings may help in risk prediction tasks. In this respect, pre-operative natriuretic peptides (NPs) concentrations are nowadays recognized as significant independent predictors of perioperative cardiovascular complications (including PAF), while elevated post-operative levels may further enhance risk stratification. The aim of the present paper is to trace the state of the art in terms of incidence, management, prevention, and outcome of PAF in the field of thoracic surgical oncology.

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Morbidity and Mortality after Major Pulmonary Resections in Patients with Locally Advanced Stage IIIA Non-small Cell Lung Carcinoma Who Underwent Induction Therapy

Cited by 9 publications

References 24 publications

Perioperative outcomes and lymph node assessment after induction therapy in patients with clinical N1 or N2 non-small cell lung cancer

Perioperative outcomes and lymph node assessment after induction therapy in patients with clinical N1 or N2 non-small cell lung cancer

Right-Sided Versus Left-Sided Pneumonectomy After Induction Therapy for Non-Small Cell Lung Cancer

Incidence, Management, Prevention and Outcome of Post-Operative Atrial Fibrillation in Thoracic Surgical Oncology

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