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Assessment of extensive surgery for locally advanced lung cancer

Safety and efficacy of induction therapy
  • Hiroshi Niwa
  • Katsumi Nakamae
  • Takeshi Yamada
  • Hisanori Kani
  • Katsutoshi Maemoto
  • Takeo Mizuno
Original Article

Abstract

Objective: Locally advanced lung cancer has a poor prognosis, despite extensive surgery conducted in an effort to improve survival. We evaluated the safety and efficacy of induction therapy prior to extensive surgery for locally advanced lung cancer. Methods: Primary resection for lung cancer was done in 549 consecutive patients divided into three groups; 446 undergoing standard pulmonary resection (no extensive surgery), 87 undergoing extensive surgery without induction therapy, and 16 undergoing surgery after induction therapy. Results: Morbidity was 23.5%, 28.6%, and 43.8%, respectively. The rate was significantly higher in the induction group compared with the no extensive surgery group (P < 0.05). Surgical mortality was 0.67%, 3.4%, and 6.3%, respectively. The difference was statistically significant between the no extensive surgery and extensive surgery groups (P < 0.02), and between the no extensive surgery and induction groups (P < 0.02). Hospital mortality was 2.2%, 9.2%, and 6.3%, respectively. The rates were significantly higher in the extensive surgery (P < 0.01) and induction (P < 0.05) groups compared to the no extensive surgery group. Five-year survival was 50.3% for the patients who received induction therapy, and 14.7% for the patients who did not receive induction therapy. Conclusions: Survival differences between the induction and non induction groups were not significant, but some patients with T3 or T4 disease may benefit from induction therapy. The high morbidity of induction treatment should be recognized, and strict candidate selection and careful postoperative care used to help prevent increased mortality.

Index words

locally advanced lung cancer extensive surgery induction chemotherapy induction chemoradiotherapy bronchoplasty 

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Copyright information

© The Japanese Society of Thoracic and Cadiovascular Surgery 1999

Authors and Affiliations

  • Hiroshi Niwa
    • 1
  • Katsumi Nakamae
    • 1
  • Takeshi Yamada
    • 1
  • Hisanori Kani
    • 1
  • Katsutoshi Maemoto
    • 1
  • Takeo Mizuno
    • 1
  1. 1.Division of Thoracic Surgery, Respiratory Disease CenterSeirei Mikatabara General HospitalShizuokaJapan

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