SAFETY AND EFFICACY OF BRONCHOVASCULAR RECONSTRUCTION AFTER INDUCTIONCHEMOTHERAPY FOR LUNG-CANCER

Objective: The aim of this study was to ascertain the safety and effic acy of bronchial sleeve resection and reconstruction of the pulmonary artery in patients who had undergone induction chemotherapy for lung c ancer, Methods: Between January 1981 and July 1996, we operated on 68 patients who had received three cycles of cisplatin-based induction ch emotherapy. In 27 of these cases, we performed a lobectomy (n = 25) or bilobectomy (n = 2) associated with reconstruction of the bronchus, t he pulmonary artery, or both, In only five additional patients, pneumo nectomy had to be carried out, Before chemotherapy, 14 patients were i n stage IIIA and 13 were in stage IIIB, All patients in stage IIIB had T4 disease; no N3 cases mere included, At thoracotomy, one patient ha d no evidence of tumor, six were in stage I, 13 were in stage II, six were in stage IIIA, and one was in stage IIIB, Sixteen patients had ep idermoid carcinoma and 11 had adenocarcinoma, Results: Sixteen patient s underwent bronchial sleeve resection; 11 had various types of pulmon ary artery reconstruction, associated with the bronchial sleeve in eig ht eases, In 26 patients, resection was radical with histologically ne gative margins. Neither bronchial complications nor deaths occurred, O ne patient had empyema and two had wound infections, Mean chest tube d uration was 6 days, After a postoperative follow-up of 4 to 69 months (mean 25 months), 14 patients are alive and free of disease, one is al ive with disease, and 12 have died, There were no local recurrences, T he 1- and 4-year survival rates are 78% and 39%, respectively, Conclus ions: Although it is technically demanding, lobectomy associated with bronchovascular reconstruction is feasible, with good immediate and lo ng-term results, after induction chemotherapy.