Complications
of Extended Lung Resection Procedures Following the Neoadjuvant Therapy
Klein J., Král V., Neoral Č., Bohanes T., Aujeský R.1, Kolek V.2, Heřman M.3
1. I. chirurgická klinika LF UP a FN Olomouc, přednosta prof. MUDr. Vladimír Král, CSc. 2 Klinika TRN LF UP a FN Olomouc, přednosta prof. MUDr. Vítězslav Kolek, DrSc. 3 Radiologická klinika LF UP a FN Olomouc, přednosta prof. MUDr. Josef Nekula, CSc. |
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Summary:
Local tumor expansion in the sense of the tumor invasion into the extrapulmonary structures, which must
be removed in one step, preferably en-bloc, together with the primary tumor, is the reason for extending the lung
resection procedure. Although verified lymphogenic metastasing into either unilateral, eventually into contralateral
mediastinal lymphonodes (stage N2 resp. N3, according to the TNM), remains the commonest indication for
the induction therapy in cases of the lung carcinoma, application of the neoadjuvant therapy in cases when
extended resections may be expected, is indicated in case the tumor expands into the surrounding structures,
which signifies opening of new, unnatural routes of possible lymphogenic and haematogenic dissemination, and
thus, a significantly higher risk of the surgical therapy failure.
During the period 1995–2002, our team conducted 15 extended lung resection procedures following the
preceding induction therapy in patients suffering from the IIB – IIIB stage of the non-smallcellular lung
carcinoma (NSCLC). The 30-day lethality rate equalled zero. We recorded two rare complications and the postoperative
morbidity was acceptable.
Conclusion: Exhausting staging, the best possible prediction of the tumor behaviour following the surgical
procedure and minimal surgical complications remain the prerequisite for good long- term results following the
extended lung resections for the lung carcinoma. Application of the neoadjuvant therapy prior to the resection
procedure need not increase the risk of surgical complications and, furthermore, may positively affect the disease
prognosis.
Key words:
the lung carcinoma – NSCLC – surgery – complications – extended resection procedures –
neoadjuvant therapy – induction
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