Post-operative complications after radiochemotherapy or chemotherapy for lung cancer

Objective. The purpose of this study was to evaluate the risk of lung cance r surgery, following induction chemo and/or radiotherapy. Methods. This retrospective study included 69 patients treated from January 1990 to January 1998 for a primary lung cancer in whom surgery had been pe rformed after induction treatment. Surgery had not been considered initiall y for the following reasons: N2 disease (IIIA: n = 25), temporary functiona l impairment (2 stages IB and 2 stages IIIA [N2]: n = 4): doubtful resectab ility (stage IIIB [T4]; n = 40). The medical regimen resulted in combined r adio-chemotherapy in 43 patients who received 2 to 4 cycles of chemotherapy (average = 2.9 +/- 0.8 cycles) and 43 +/- 8 Gy (20 to 60 Gy), or chemother apy alone in 26 patients (3 +/- 0.7 cycles). Results. Exploratory thoracotomy was performed in 4 patients (6%). The in-h ospital mortality was 9% (n = 6) from respiratory origin in all cases. Ther e were 4 reoperations (6%): 3 for bronchial fistula and 1 for bleeding. Thi rty five patients (51%) required blood transfusion (4.5 +/- 3.8 cell packs) . The incidence of early and delayed bronchial fistula after pneumonectomy was 15%. Thirteen patients had a postoperative pneumonia (19%). Conclusion. Surgery for lung cancer after induction chemo and/or radiothera py is associated with an increased risk. While the mortality seems "accepta ble", the morbidity rate however is high.