Abstract
Objective The aim of this study was to identify predictors of postoperative outcome and survival of locally advanced non-small cell lung carcinoma (NSCLC) resections after neoadjuvant chemotherapy or chemoradiation.Methods Medical records of all patients with clinical stage III potentially resectable NSCLC initially treated by neoadjuvant chemotherapy or chemoradiation followed by major pulmonary resections between 1999 to 2019 were retrieved from the databases of four Israeli Medical Centers. Results: The 124 suitable patients included, 86 males (69.4%) and 38 females (30.6%), mean age of 64.2 years (range 37-82) and mean hospital stay of 12.6 days (range 5-123). Complete resection was achieved in 92.7% of the patients, while complete pathologic response was achieved in 35.5%. Overall readmission rate was 16.1%. The overall 5-year survival rate was 47.9%. One patient (0.8%) had local recurrence. Postoperative complications were reported in 49.2% of the patients, mainly atrial fibrillation (15.9%) and pneumonia (13.7%), empyema (10.3%), and early bronchopleural fistula (7.3%). Early in-hospital mortality rate was 6.5% and the six-month mortality rate was 5.6%. Pre-neoadjuvant bulky mediastinal disease (lymph nodes >20 mm) (p=0.034), persistent postoperative N2 disease (p=0.016), R1 resection (p=0.027) and postoperative stage IIIA (p=0.001), emerged as negative predictive factors for survival. Conclusions: Our findings demonstrate that neoadjuvant chemotherapy or chemoradiation in locally advanced potentially resectable NSCLC followed by major pulmonary resection is a beneficial approach in selected cases.
ROLE OF SURGERY IN THE TREATMENT OF SMALL CELL LUNG CARCINOMA