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

Details

Serval ID
serval:BIB_AC8BE5624D74
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Is sleeve lobectomy safe after induction therapy?—a systematic review and meta-analysis
Journal
Journal of Thoracic Disease
Author(s)
Chriqui Louis-Emmanuel, Forster Céline, Lovis Alban, Bouchaab Hasna, Krueger Thorsten, Perentes Jean Yannis, Gonzalez Michel
ISSN
2072-1439
2077-6624
Publication state
In Press
Volume
0
Number
0
Pages
0-0
Language
english
Abstract
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 MantelHaenszel 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.
Keywords
Sleeve lobectomy (SL), induction therapy, anastomosis complication, survival, thoracic surgery
Web of science
Open Access
Yes
Create date
01/10/2021 17:05
Last modification date
19/11/2021 6:40
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