Comacchio Giovanni M, Schiavon Marco, Azzolina Danila, Mammana Marco, Marulli Giuseppe, Zuin Andrea, Verderi Enrico, Monaci Nicola, Bonanno Laura, Pasello Giulia, Rea Federico
Division of Thoracic Surgery, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy.
World J Surg. 2019 May;43(5):1385-1392. doi: 10.1007/s00268-019-04908-0.
Sleeve lobectomy represents a safe and effective treatment for central NSCLC to avoid the risks of pneumonectomy. Induction therapy (IT) may be indicated in advanced stages; however, the effect of IT on bronchial anastomoses remains uncertain. The purpose of the study was to evaluate the impact of IT on the complications of the anastomoses.
Between 2000 and 2012, 159 consecutive patients were submitted to sleeve lobectomy for NSCLC at our Institution. We retrospectively compared the results of patients who underwent IT before operation with those who received upfront surgery.
In the study period, 49 (30.8%) patients received IT (37 chemotherapy, 1 radiotherapy and 11 chemo-radiotherapy) and 110 (69.2%) patients were directly submitted to surgery (S). The two groups were comparable for sex, age, comorbidities, ASA score, pulmonary function, side, type of procedure and histology. Pathological stage was statistically higher for IT group (p = 0.001). No differences between IT and S groups were observed in terms of post-operative mortality (2% vs 0%, p = NS), morbidity (45% vs 38%, p = NS), including early (6% vs 9%, p = NS) and long-term (16% vs 14%, p = NS) bronchial complication rates. Patients undergoing induction mediastinal radiotherapy, however, are at higher risk of bronchial complications.
In our experience, the use of induction chemotherapy did not significantly increase mortality and morbidity rates, in particular, neither for early nor for late anastomotic complications. We, therefore, conclude that sleeve lobectomy after induction chemotherapy is safe and reliable procedure for the treatment of locally advanced NSCLC.
袖状肺叶切除术是治疗中央型非小细胞肺癌（NSCLC）的一种安全有效的方法，可避免全肺切除术的风险。诱导治疗（IT）可能适用于晚期患者；然而，IT对支气管吻合口的影响仍不确定。本研究的目的是评估IT对吻合口并发症的影响。
2000年至2012年期间，我院159例连续的NSCLC患者接受了袖状肺叶切除术。我们回顾性比较了术前接受IT治疗的患者与直接接受手术的患者的结果。
在研究期间，49例（30.8%）患者接受了IT治疗（37例化疗，1例放疗，11例放化疗），110例（69.2%）患者直接接受了手术（S）。两组在性别、年龄、合并症、ASA评分、肺功能、手术侧别、手术类型和组织学方面具有可比性。IT组的病理分期在统计学上更高（p = 0.001）。IT组和S组在术后死亡率（2% vs 0%，p = NS）、发病率（45% vs 38%，p = NS）方面未观察到差异，包括早期（6% vs 9%，p = NS）和长期（16% vs 14%，p = NS）支气管并发症发生率。然而，接受诱导纵隔放疗的患者发生支气管并发症的风险更高。
根据我们的经验，使用诱导化疗并没有显著增加死亡率和发病率，特别是对于早期和晚期吻合口并发症。因此，我们得出结论，诱导化疗后行袖状肺叶切除术是治疗局部晚期NSCLC的一种安全可靠的方法。
