Postoperative complications in relation with induction therapy for lung cancerq

Objectives: The purpose of this study was to evaluate the risk of lung cancer surgery following induction chemotherapy and/or radio-therapy. Methods: 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 (IIIA, n 25); temporary functional impairment (two stages IB and two stages IIIA (N2), n 4); and doubtful resectability (stage IIIB (T4), n 40). The medical regimen resulted in combined radio-chemotherapy in 43 patients who received two to four cycles of chemotherapy (average 2.9 ^ 0.8 cycles) and 43 ^ 8 Gy (range 20±60 Gy), or chemotherapy alone in 26 patients (3 ^ 0.7 cycles). Results: Exploratory thoracotomy was performed in four patients (6%). The in-hospital mortality was 9 % (n 6) from respiratory origin in all cases. There were four re-operations (6%): three for bronchial ®stula and one for bleeding. Thirty-®ve patients (51%) required blood transfusion (4.5 ^ 3.8 cell packs). The incidence of early and delayed bronchial ®stula after pneumonectomy was 15%. Thirteen patients had a postoperative pneumonia (19%). Conclusions: Surgery for lung cancer after induction chemotherapy and/or radiotherapy is associated with an increased risk. If th