Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Risk Factor Analysis of Morbidity and 90-Day Mortality of Curative Resection in Patients with Stage IIIA-N2 Non-Small Cell Lung Cancer after Induction Concurrent Chemoradiation Therapy

  • Ga Hee Jeong (Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Junghee Lee (Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yeong Jeong Jeon (Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seong Yong Park (Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hong Kwan Kim (Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yong Soo Choi (Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jhingook Kim (Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Young Mog Shim (Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jong Ho Cho (Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2023.11.27
  • Accepted : 2024.01.26
  • Published : 2024.07.05
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Abstract

Background: Major pulmonary resection after neoadjuvant concurrent chemoradiation therapy (nCCRT) is associated with a substantial risk of postoperative complications. This study investigated postoperative complications and associated risk factors to facilitate the selection of suitable surgical candidates following nCCRT in stage IIIA-N2 non-small cell lung cancer (NSCLC). Methods: We conducted a retrospective analysis of patients diagnosed with clinical stage IIIA-N2 NSCLC who underwent surgical resection following nCCRT between 1997 and 2013. Perioperative characteristics and clinical factors associated with morbidity and mortality were analyzed using univariable and multivariable logistic regression. Results: A total of 574 patients underwent major lung resection after induction CCRT. Thirty-day and 90-day postoperative mortality occurred in 8 patients (1.4%) and 41 patients (7.1%), respectively. Acute respiratory distress syndrome (n=6, 4.5%) was the primary cause of in-hospital mortality. Morbidity occurred in 199 patients (34.7%). Multivariable analysis identified significant predictors of morbidity, including patient age exceeding 70 years (odds ratio [OR], 1.8; p=0.04), low body mass index (OR, 2.6; p=0.02), and pneumonectomy (OR, 1.8; p=0.03). Patient age over 70 years (OR, 1.8; p=0.02) and pneumonectomy (OR, 3.26; p<0.01) were independent predictors of mortality in the multivariable analysis. Conclusion: In conclusion, the surgical outcomes following nCCRT are less favorable for individuals aged over 70 years or those undergoing pneumonectomy. Special attention is warranted for these patients due to their heightened risks of respiratory complications. In high-risk patients, such as elderly patients with decreased lung function, alternative treatment options like definitive CCRT should be considered instead of surgical resection.

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References

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