%0 Journal Article
%T Pneumonectomy is safe and effective for non-small cell lung cancer following induction therapy
%A Abby White
%A Ciaran McNamee
%A Daniel N. Lee
%A Elliot Servais
%A Jon Wee
%A Michael Jaklitsch
%A Raphael Bueno
%A Scott J. Swanson
%A Steven Mentzer
%A Suden Kucukak
%A Yolonda Colson
%J SCIE-indexed Journal
%D 2017
%R 10.21037/jtd.2017.10.92
%X The first report of pneumonectomy for lung cancer was published in the Journal of American Medical Association (JAMA) in 1933 and was performed by Dr. Graham (1). His patient, Dr. Gilmore, an obstetrician from Pittsburgh, would go on to outlive the surgeon himself. As our understanding of the biology of lung cancer and the physiologic consequences of pneumonectomy evolved, so did the techniques and treatments for locally advanced lung cancer, which often include a combination of chemotherapy, radiation and surgery. The Intergroup trial (2), a randomized study published in 2009 and comparing neoadjuvant chemoradiotherapy plus surgery to chemoradiotherapy alone, issued caution regarding pneumonectomy in the context of multimodality therapy. This was largely due to inexplicable surgical results in this series, which demonstrated morbidity and mortality higher than published averages (26%). Yet pneumonectomy continues to be advocated in this setting by high volume centers that achieve superior surgical morbidity and mortality (3-6). Our initial experience in 73 patients demonstrated favorable morbidity and mortality (7). A systematic review of pneumonectomy followed by neoadjuvant therapy was published in 2012 (8). The report included 27 studies from 1990¨C2010, and included 4 randomized controlled studies, including the Intergroup trial. Mortality at 30 days was 7% and at 90 days was 12%, suggesting traditional reporting of 30-day mortality may not be the ideal marker of perioperative mortality for pneumonectomy patients. A recently published query of a large-volume national database; however, suggests patients with stage IIIA non-small cell lung cancer (NSCLC) receive neoadjuvant chemoradiotherapy without survival benefit over upfront surgery with adjuvant therapy (9). Importantly, patients with final positive margins were excluded, and mortality was only reported at 30-days. The ideal treatment for patients with locally advanced NSCLC, who require pneumonectomy for resection, remains controversial. This study sought to evaluate the safety and efficacy of pneumonectomy following neoadjuvant chemoradiation therapy in our institution over a 15-year period
%U http://jtd.amegroups.com/article/view/16780/html