Roberts J R, Eustis C, Devore R, Carbone D, Choy H, Johnson D
Department of Cardiac and Thoracic Surgery, Vanderbilt University Hospital, Nashville, Tennessee 37232, USA.
Ann Thorac Surg. 2001 Sep;72(3):885-8. doi: 10.1016/s0003-4975(01)02836-3.
Neoadjuvant chemotherapy before resection is the standard of care for stage IIIA non-small cell lung cancer in many institutions. Further, neoadjuvant therapy is being studied in earlier stage lung cancer and may be applied more broadly in the future. There is little information about the effect of preoperative chemotherapy on the perioperative complications and mortality after lung resection.
All patients undergoing anatomic resection after neoadjuvant chemotherapy by a single surgeon at a single institution were compared with patients undergoing similar resections without preoperative chemotherapy. Complications were analyzed as life-threatening (pneumonia, emergency surgery, transfer to the intensive care unit, or intubation), major (prolonging hospital stay but not necessarily dangerous), and minor. The incidence of life-threatening complications, major complications, reintubation, tracheostomy, and mortality were analyzed to determine whether neoadjuvant chemotherapy might have an effect on these complications. Mortality was defined as hospital mortality. Two-tailed Student's t test was used to analyze differences in means and chi2 to determine differences in proportions. Differences less than 0.05 were considered significant.
Thirty-four patients underwent resection after neoadjuvant chemotherapy, and 67 patients underwent resection without preoperative therapy. No differences between the two groups in age, pulmonary function, or comorbid diseases were found. The patients receiving chemotherapy did have a more advanced stage (2.52 versus 1.55, p < 0.0001). Striking increases were found in incidence of life-threatening complications (6.0% versus 26.5%, p = 0.0036), major complications (19.4% versus 47.1%, p = 0.0037), reintubation (3.0% versus 17.6%, p = 0.0093), and tracheostomy (0% versus 11.8%, p = 0.0042) in those patients who received preoperative chemotherapy. There was no hospital mortality. However, 2 (neoadjuvant) patients died within 90 days after discharge from the hospital of pneumonia and pulmonary embolus. This difference was also significant (0% versus 5.89%, p = 0.045).
Neoadjuvant carboplatin and Taxol increased the perioperative life-threatening complications in this cohort of patients compared with a similar cohort undergoing operations by the same surgeon in the same institution. The most common life-threatening complication in patients receiving induction chemotherapy was the failure to respond to antibiotics given for pneumonia. Strategies to prevent these complications will be important, especially if chemotherapy before resection becomes the standard for earlier stages of non-small cell lung cancer.
在许多机构中，术前新辅助化疗是ⅢA期非小细胞肺癌的标准治疗方法。此外，新辅助治疗正在早期肺癌中进行研究，未来可能会更广泛地应用。关于术前化疗对肺切除术后围手术期并发症和死亡率的影响，相关信息较少。
将在单一机构由同一位外科医生进行新辅助化疗后接受解剖性切除的所有患者，与未接受术前化疗而进行类似切除的患者进行比较。并发症分为危及生命的（肺炎、急诊手术、转入重症监护病房或插管）、主要的（延长住院时间但不一定危险）和次要的。分析危及生命的并发症、主要并发症、再次插管、气管切开术的发生率以及死亡率，以确定新辅助化疗是否可能对这些并发症产生影响。死亡率定义为医院死亡率。采用双尾学生t检验分析均值差异，采用卡方检验确定比例差异。差异小于0.05被认为具有统计学意义。
34例患者在新辅助化疗后接受了切除，67例患者未接受术前治疗即接受了切除。两组在年龄、肺功能或合并症方面未发现差异。接受化疗的患者分期更高（2.52对1.55，p<0.0001）。接受术前化疗的患者中，危及生命的并发症发生率（6.0%对26.5%，p = 0.0036）、主要并发症发生率（19.4%对47.1%，p = 0.0037）、再次插管率（3.0%对17.6%，p = 0.0093）和气管切开术发生率（0%对11.8%，p =
