Morbidity and mortality after neoadjuvant therapy and sleeve lobectomyin N2-disease

Background and objective Sleeve resections were introduced to preserve lung function in patients with limited pulmonary reserve.Increasing experience with sleeve resection has reduced the rate of pneumonectomy below 10%.The aim of the study was to assess the outcome after neoadjuvant chemo-or chemoradiotherapy and sleeve resection in patients with N2 non-small cell lung cancer.Methods Retrospective analysis of 41 patient records between 01.01.2005 and 31.12.2007 underwent induction therapy in N2-disease followed by tracheobronchial sleeve resection.These patients were compared to the overall results after sleeve resection in our institution.Data analysed were;length of chest tube drainage in days,length of hospital stay,complications,morbidity and hospital mortality.Results In 178 patients,an anatomical bronchoplastic resection was performed.Preoperative chemotherapy in N2-disease(n=42) was given in 30 patients and radiochemotherapy in 11 patients.The length of the operation was between 94 min-493 min(average 143 min).Chest tubes were removed on average after 5 days.Patients were discharged after 10 days.R0-resection was possible in 90%.The overall complication rate was 27%(11/41).The rate of bronchial anastomotic leakage was 9.7%(4/41).Two patients with postoperative respiratory insufficiency and mechanical ventilation,1 patient with technical failure required early correction of the suture and one patient with a necrosis of the anastomosis.30-day hospital mortality rate was 2.4%(1/41).Conclusion Sleeve resection after neoadjuvant therapy has a higher local morbidity(anastomotic insufficiency 9.7% vs 2.8%).This may be explained by the quality of the surrounding tissue after neoadjuvant therapy,which compromises healing of the anastomosis.However,the results are comparable to those without induction therapy in terms of radicality,and 30-d mortality rate(P>0.05).We therefore believe that sleeve resection after neoadjuvant therapy should be performed whenever possible to preserve functioning lung tissue.