Is sleeve lobectomy safe after induction therapy?—a systematic review and meta-analysis

Journal of Thoracic Disease

article

Louis-Emmanuel Chriqui¹  Céline Forster¹  Alban Lovis²  Hasna Bouchaab⁴  Thorsten Krueger¹  Jean Yannis Perentes¹  Michel Gonzalez¹ 

[1] Service of Thoracic Surgery. University Hospital of Lausanne;Service of Pneumology. University Hospital of Lausanne;University of Lausanne;Service of Oncology University Hospital of Lausanne

关键词: Sleeve lobectomy (SL);    induction therapy;    anastomosis complication;    survival;    thoracic surgery;   

DOI  :  10.21037/jtd-21-939

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: Sleeve lobectomy (SL) is a lung-sparing procedure, which is accepted as a valid operation for centrally-located advanced tumors. These tumors often require induction treatment by chemotherapy and/or radiotherapy to downstage the disease and thus facilitate subsequent surgery. However, induction therapy may potentially increase the risk of bronchial anastomotic complications and related morbidity. This meta-analysis aims to determine the impact of induction therapy on the outcomes of pulmonary SL. Methods: We compared studies of patients undergoing SL or bilobectomy for non-small cell lung cancer (NSCLC) with and without induction therapy. Outcomes of interest were in-hospital mortality, morbidity, anastomosis complication and 5-year survival. Odds ratio (OR) were computed following the Mantel-Haenszel method. Results: Ten studies were included for a total of 1,204 patients. There was no statistical difference for between patients who underwent induction therapy followed by surgery and patients who underwent surgery alone in term of post-operative mortality (OR: 1.80, 95% confidence interval (CI): 0.76–4.25, P value =0.19) and morbidity (OR: 1.17, 95% CI: 0.90–1.52, P value =0.237). Anastomosis related complications rate were 5.2% and appears increased after induction therapy with a statistical difference close to the significance (OR: 1.65, 95% CI: 0.97–2.83, P value =0.06). Patients undergoing surgery alone showed better survival at 5 years (OR: 1.52, 95% CI: 1.15–2.00, P value =0.003). Conclusions: SL following induction therapy can be safely performed with no increase of mortality and morbidity. However, the need for induction therapy before surgery is associated with increased anastomotic complications and poorer survival prognosis at 5 years.

【 授权许可】

Unknown