The recently reported experiences by Doddoli [1], Novoa [2], Martin [3] and Voltolini [4], add useful informations on post-operative morbi-mortality when patients with non small cell lung cancer (NSCLC) are operated after induction treatment (IT). Even if the variability of reported ITs is a limiting factor to draw valuable conclusions the general idea is that an higher morbidity rate is expected when radiotherapy is included in the IT and when a pneumonectomy is performed at the time of operation. The importance of the impact of these two variables post-operatively has, however, never been confirmed with functional evidences. In fact, a comprehensive pulmonary function evaluation in an IT series remains hitherto unreported. We reviewed the records of 22 stage IIIa patients, operated after IT with concurrent radiochemotherapy as described elsewhere [5] between June 1992 and May 1994 (group 1). We selected (1:3 ratio) 61 control cases among the NSCLC patients operated in the same period without a prior IT (group 2). Patients whose functional data (FVC, FEV1, TLC, RV, TLC, KCO, PaO2, PaCO2 and PA-aO2) were not complete as measured before IT, prior and after (1 month) surgery, were priorily excluded. Functional differences pre and post-operatively have been analysed (Student's t-test). Differences before and after surgery in group 1 and 2 were compared using analysis of variance (χ2-test to compare type of surgery and staging). A multiple regression analysis was performed using the parameters measured post-operatively as dependent variables and age, sex, height, entity of resection (pneumonectomy as a risk factor), IT and baseline functionality as independent variables. No differences were detected among the two groups pre-operatively. Thirty days after surgery, regardless of the entity of resection, a significant functional reduction was observed in the group 1 versus group 2 (FVC=−1.42 vs. −0.958 l; FEV1=−0.91 vs. −0.64 l; TLC=−2.45 vs. −1.64 l; PaO2=−2.87 vs. +3.86 mmHg; PA-aO2=+5.05 vs. −3.99 mmHg). In patients who underwent pneumonectomy, changes in lung volumes showed an overlap among the two groups. In patients who underwent lesser resections, function of the group 2 was better either in volumes, either in gas exchanges. Multiple regression (changes in post-operative function), after normalising data for age, entity of resection and pre-operative IT, showed a significant drop in pulmonary volumes and a worsening of intrapulmonary gas exchanges in group 1 patients (Table 1).

Granone, P., Margaritora, S., Cesario, A., Corbo, G. M., Valente, S., Trodella, L., D., G., G., F., R. M., D., Morbidity after induction therapy and surgery in non small cell lung cancer. Focus on pulmonary function, <<LUNG CANCER>>, 2002; (in press): 219-220 [http://hdl.handle.net/10807/5980]

Morbidity after induction therapy and surgery in non small cell lung cancer. Focus on pulmonary function

Granone, Pierluigi;Margaritora, Stefano;Cesario, Alfredo;Corbo, Giuseppe Maria;Valente, Salvatore;Trodella, Lucio;
2002

Abstract

The recently reported experiences by Doddoli [1], Novoa [2], Martin [3] and Voltolini [4], add useful informations on post-operative morbi-mortality when patients with non small cell lung cancer (NSCLC) are operated after induction treatment (IT). Even if the variability of reported ITs is a limiting factor to draw valuable conclusions the general idea is that an higher morbidity rate is expected when radiotherapy is included in the IT and when a pneumonectomy is performed at the time of operation. The importance of the impact of these two variables post-operatively has, however, never been confirmed with functional evidences. In fact, a comprehensive pulmonary function evaluation in an IT series remains hitherto unreported. We reviewed the records of 22 stage IIIa patients, operated after IT with concurrent radiochemotherapy as described elsewhere [5] between June 1992 and May 1994 (group 1). We selected (1:3 ratio) 61 control cases among the NSCLC patients operated in the same period without a prior IT (group 2). Patients whose functional data (FVC, FEV1, TLC, RV, TLC, KCO, PaO2, PaCO2 and PA-aO2) were not complete as measured before IT, prior and after (1 month) surgery, were priorily excluded. Functional differences pre and post-operatively have been analysed (Student's t-test). Differences before and after surgery in group 1 and 2 were compared using analysis of variance (χ2-test to compare type of surgery and staging). A multiple regression analysis was performed using the parameters measured post-operatively as dependent variables and age, sex, height, entity of resection (pneumonectomy as a risk factor), IT and baseline functionality as independent variables. No differences were detected among the two groups pre-operatively. Thirty days after surgery, regardless of the entity of resection, a significant functional reduction was observed in the group 1 versus group 2 (FVC=−1.42 vs. −0.958 l; FEV1=−0.91 vs. −0.64 l; TLC=−2.45 vs. −1.64 l; PaO2=−2.87 vs. +3.86 mmHg; PA-aO2=+5.05 vs. −3.99 mmHg). In patients who underwent pneumonectomy, changes in lung volumes showed an overlap among the two groups. In patients who underwent lesser resections, function of the group 2 was better either in volumes, either in gas exchanges. Multiple regression (changes in post-operative function), after normalising data for age, entity of resection and pre-operative IT, showed a significant drop in pulmonary volumes and a worsening of intrapulmonary gas exchanges in group 1 patients (Table 1).
Inglese
Granone, P., Margaritora, S., Cesario, A., Corbo, G. M., Valente, S., Trodella, L., D., G., G., F., R. M., D., Morbidity after induction therapy and surgery in non small cell lung cancer. Focus on pulmonary function, <<LUNG CANCER>>, 2002; (in press): 219-220 [http://hdl.handle.net/10807/5980]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/5980
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