Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERY32. Pneumonectomy After Chemo- or Chemoradiotherapy for AdvancedNon-Small Cell Lung CancerWalter Weder, 1* Stéphane Collaud, 1 Thomas Krbek, 2 Sven Hillinger, 1 Sylvia Fechner, 2Peter Kestenholz, 1 Rolf Stahel, 1 Georgios Stamatis 21. Zurich University Hospital, Zürich, Switzerland; 2. Ruhrlandklinik, Essen, GermanyInvited Discussant: Robert J. CerfolioOBJECTIVE: Pneumonectomy after chemo- or chemoradiotherapy is reported tobe associated with a mortality of up to 20%. We retrospectively reviewed medicalrecords of patients who underwent standard or extended pneumonectomy afterinduction therapy for advanced NSCLC.METHODS: 827 patients underwent induction therapy for NSCLC after stagingwith CT, PET-CT and/or mediastinoscopy in two different centers from 1998–2007.Induction chemotherapy consisted mainly of 3 cycles of a platin-based regimen.Chemoradiotherapy consisted of an additional radiation of 45 Gy. Re-staging wasperformed with CT, PET-CT and/or re-mediastinoscopy prior to surgical resection.Patients who underwent a pneumonectomy were further analyzed.RESULTS: 176 pneumonectomies were performed. 117 (66%) were extendedresections including pericardium in 108 (60%), left atrium in 31 (18%), diaphragmin 10 (6%), chest wall in 8 (5%), superior vena cava in 7 (4%), aorta in 7 (4%) andoesophageal muscle in 5 (3%) patients. R0-resection was achieved in 165 (94%).TUESDAYMorningPre-induction clinical stage was IIB in 8 (5%), IIIA in 96 (54%), IIIB in 71 (40%)and IV in 1 (1%) patient. Post-induction pathological stage was a complete responsein 36 (20%), stage I in 31 (18%), II in 39 (22%), III in 58 (33%) and IV in 12 (7%).There were 6 perioperative deaths (3% mortality) due to pulmonary embolism in3, respiratory failure (pneumonia/ARDS) in 2 and cardiac failure in 1 patient.Within 90 post-operative days, 22 major complications occurred in 19 patients(11%): 6 (27%) broncho-pleural fistulas (BPF), 6 (27%) pneumonias/ARDS, 5(23%) empyemas without BPF, 4 (18%) pulmonary embolism and 1 (5%) gastricherniation due to displacement of the diaphragmatic repair.3- and 5-year survivals for the overall population were 55% and 38%, respectively.CONCLUSION: Pneumonectomy after chemo- or chemoradiotherapy as inductionfor advanced NSCLC can be performed with a perioperative mortality rate of 3%and should not exclude patients from surgical resection. The achieved 5-year survivalrate of 38% justifies aggressive surgery within a multimodality concept forselected cases.10:05 a.m. INTERMISSION – VISIT EXHIBITSExhibit Hall* AATS Member157