Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Jul 28, 2016; 6(2): 19-29
Published online Jul 28, 2016. doi: 10.5412/wjsp.v6.i2.19
Surgical outcomes of pulmonary resection for lung cancer after neo-adjuvant treatment
Benedetto Mungo, Cheryl K Zogg, Francisco Schlottmann, Arianna Barbetta, Craig M Hooker, Daniela Molena
Benedetto Mungo, Cheryl K Zogg, Craig M Hooker, Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21211, United States
Francisco Schlottmann, Arianna Barbetta, Daniela Molena, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
Author contributions: Mungo B and Molena D contributed to design of the study, acquisition of data, analysis and interpretation of data, drafting the article and critical revision for important intellectual content and final approval of the version to be submitted; Zogg CK contributed to acquisition of data, analysis and interpretation of data, drafting the article, and final approval of the version to be submitted; Schlottmann F and Barbetta A contributed to critical revision for important intellectual content, manuscript revision and editing; Hooker CM contributed to analysis and interpretation of data, critical revision for important intellectual content and final approval of the version to be submitted.
Institutional review board statement: The study was deemed exempt from ethical review by the Johns Hopkins University School of Medicine Institutional Review Board.
Informed consent statement: We used a de-identified administrative dataset for which consent is not required.
Conflict-of-interest statement: The authors have no conflict of interest to disclose in relation to the present work.
Data sharing statement: No additional data are available. American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daniela Molena, MD, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. molenad@mskcc.org
Telephone: +1-212-6393870 Fax: +1-646-2277106
Received: April 27, 2016
Peer-review started: April 29, 2016
First decision: June 30, 2016
Revised: July 13, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: July 28, 2016
Abstract

AIM: To evaluate the outcomes of surgery for lung cancer after induction therapy.

METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2012), we identified 4063 patients who underwent a pulmonary resection for lung cancer. Two hundred and thirty-six (5.8%) received neo-adjuvant therapy prior to surgery (64 chemo-radiation, 103 radiation alone, 69 chemotherapy alone). The outcomes were compared to 3827 patients (94.2%) treated with surgery alone. Primary outcome was 30-d mortality, and secondary outcomes included length of stay, operative time and NSQIP measured postoperative complications.

RESULTS: Lung cancer patients who received preoperative treatment were younger (66 vs 69, P < 0.001), were more likely to have experienced recent weight loss (6.8% vs 3.5%; P = 0.011), to be active smokers (48.3 vs 34.9, P < 0.001), and had lower preoperative hematological cell counts (abnormal white blood cell: 25.6 vs 13.4; P < 0.001; low hematocrit 53% vs 17.3%, P < 0.001). On unadjusted analysis, neo-adjuvant patients had significantly higher 30-d mortality, overall and serious morbidity (all P < 0.001). Adjusted analysis showed similar findings, while matched cohorts comparison confirmed higher morbidity, but not higher early mortality.

CONCLUSION: Our data suggest that patients who receive neo-adjuvant therapy for lung cancer have worse early surgical outcomes. Although NSQIP does not provide stage information, this analysis shows important findings that should be considered when selecting patients for induction treatment.

Keywords: Lung cancer, Pulmonary resection, Neo-adjuvant therapy, Surgical outcomes

Core tip: The aim of this retrospective study was to evaluate the results of lung cancer patients undergoing surgery after induction treatment. Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified 4063 patients who underwent lung resection for cancer. Two hundred and thirty-six (5.8%) underwent neo-adjuvant therapy. The results were compared to 3827 patients (94.2%) who underwent upfront surgery. On unadjusted and adjusted analysis, neo-adjuvant patients had significantly higher 30-d mortality, overall and serious morbidity than patient treated with surgery alone. Matched cohorts comparison confirmed higher morbidity, but not higher early mortality.