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Risk Stratification for Lung Cancer Surgery^*

Impact of Induction Therapy and Extended Resection

^* From the Departments of Anesthesiology (Dr. Matsubara) and General Thoracic Surgery (Dr. Takeda), Toneyama National Hospital, Toyonaka City, Osaka, Japan; and the Department of Acute Critical Medicine (Anesthesiology) [Dr. Mashimo], Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.

Correspondence to: Shin-ichi Takeda, MD, FCCP, Toneyama National Hospital, Toneyama 5–1-1, Toyonaka 560-8552, Japan; e mail: stakeda{at}toneyama.hosp.go.jp

Study objectives: Current surgical strategies for lung cancer are directed toward the following two distinct targets: the increased prevalence of early-stage lung cancer; and locally advanced lung cancer treated with induction therapy (IT). To establish the risk stratification for operative morbidity from this viewpoint, we evaluated the impact of IT and/or an extended surgical procedure on operative results.

Design: Retrospective study.

Setting: A 674-bed teaching hospital.

Patients and methods: The morbidity and mortality of 758 consecutive patients who underwent surgery for the treatment of non-small cell lung cancer were analyzed. There were 666 patients who underwent surgery alone (S group; 560 standard lobectomies and 106 extended resections) and 92 patients who received IT (IT group; 35 standard lobectomies and 57 extended resections). Comparisons between the groups were performed using unpaired t tests or ² tests. Univariate and multivariate logistic regression analyses were used to determine the risk factors for operative morbidity and mortality.

Results: IT and extended surgery were strong independent factors for predicting postoperative morbidity (p < 0.0001). Significant differences were observed for pathologic stage (p < 0.0001), preoperative hemoglobin and DLCO levels (p < 0.001), the ratio of extended resection (p < 0.0001), and operation time and intraoperative bleeding (p < 0.001) between the S and IT groups. The overall morbidity and mortality rates were 16.8% and 0.9%, respectively, in the S group, and 55.4% and 5.4%, respectively, in the IT group (p < 0.01). The overall morbidity and mortality rates were 63.2% and 7.0%, respectively, for extended resection after IT, and 12.8% and 0.3%, respectively, for those who underwent a standard resection without IT.

Conclusions: The morbidity and mortality of lung resection are both significantly increased after IT, and the patients with the greatest risk are those who have undergone IT and extended resection. The impact of IT on risk stratification should be emphasized in perioperative care.

Key Words: extended surgery • induction therapy • lung cancer • pulmonary resection • risk stratification

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