Medical complications of combined surgical and nonsurgical therapy

The poor prognosis of patients with preoperatively identified stage IIIa N2 non-small-cell lung cancer has led to the use of various combinations of c hemotherapy, radiation, and surgery in phase it clinical trials and, more r ecently, as standard therapy. The survival benefits of these combination ap proaches have been noted, but the morbidity associated with these approache s has received less attention. Compared with surgery alone, combination tre atments almost always lead to a higher percentage of patients requiring pne umonectomy and greater numbers of complex resections and technical problems . The risks for postoperative complications and death can also be expected to be higher. It is well documented, for example, that pulmonary morbidity related to the adult respiratory distress syndrome and bronchopleural fistu lae is increased when pneumonectomy is done after chemoradiation therapy. O ther toxicities that can affect the fate of the surgical patient include my elosuppression, cardiomyopathy, and renal disorders. Fortunately, the prope r performance of anesthesia and surgery can minimize the incidence of these toxicities and reduce their effect on patients. (C) 2000 Lippincott Willia ms & Wilkins, Inc.