Hüseyin MELEK, Süreyya SARIHAN, Türkkan EVRENSEL, Gamze ÇETİNKAYA, Cengiz GEBİTEKİN, Ahmet Sami BAYRAM, Mehmet Muharrem EROL, Elif ÜLKER AKYILDIZ

Neoadjuvan tedavi sonrası pnömonektomi

Amaç: Bu çalışmada küçük hücreli dışı akciğer kanserli (KHDAK) hastalarda neoadjuvan tedavinin pnömonektomi sonrası morbidite, mortalite ve sağkalım üzerine etkisinin gösterilmesi amaçlandı.Çalışmaplanı:Kasım 1995 - Ağustos 2012 tarihleri arasında kliniğimizde KHDAK için pnömonektomi uygulanan 130 hastanın dosyaları retrospektif olarak incelendi. Başka malignitesi veya uzak metastazı olan ve tamamlama pnömonektomisi yapılan hastalar çalışmaya dahil edilmedi, kalan 116 hasta (113 erkek, 3 kadın; ort. yaş 57 yıl; dağılım 31-82 yıl) çalışma grubunu oluşturdu. İleri evre (T3-4N0-1 veya T1-3N2) KHDAK'si olan 47 hastaya (grup 1) neoadjuvan tedavi uygulandı. T2-4N0-1olan 69 hastaya (grup 2) neoadjuvan tedavisiz pnömonektomi uygulandı. Gruplar arasında sağkalım, morbidite ve mortalite oranları karşılaştırıldı.Bul gu lar: Altmış iki hastaya (%53) sol pnömonektomi yapıldı. Hastanede ortalama yatış süresi 6.4 gün idi (dağılım 1-33 gün). Ameliyat öncesi 29 hastaya (%62) kemoterapi, 18 hastaya (%38) kemoradyoterapi uygulandı. Neoadjuvan tedavi sonrası 29 hastaya sol pnömonektomi uygulandı. Hastaların %31'inde (grup 1: %28, grup 2: %33) komplikasyon saptandı. Doksan günlük mortalite oranı grup 1'de %4.2, grup 2'de %5.8 idi. Beş yıllık sağkalım oranı grup 1 ve grup 2 için sırasıyla %41 ve %35 idi. Ortalama sağkalım süresi grup 1 ve grup 2 için sırasıyla 41 ay ve 40 ay idi. İki grup arasında morbidite, mortalite ve sağkalım açısından istatistiksel olarak anlamlı fark saptanmadı.So nuç: Bu çalışmada, lokal ileri evre KHDAK hastalarında neoadjuvan tedavi sonrası pnömonektominin kabul edilebilir morbidite, mortalite ve sağkalım oranları ile güvenli bir şekilde uygulanabildiği gösterilmiştir.

Pneumonectomy after neoadjuvant treatment

Background: This study was conducted to investigate the effect of pneumonectomy after neoadjuvant therapy on survival, morbidity, and mortality in patients with non small cell carcinoma (NSCLC). Methods: Files of 130 patients who were performed pneumonectomy in our clinic for NSCLC between November 1995 and August 2012 were retrospectively reviewed. Patients with other malignancies and/or distant metastasis, and who underwent completion pneumonectomy were excluded, and the remaining 116 patients (113 males, 3 females; mean age 57 years; range 31 to 82 years) constituted the study group. Neoadjuvant treatment was administered to 47 patients (group 1) who had advanced stage (T3-4N0-1 or T1-3N2) NSCLC. Pneumonectomy without neoadjuvant treatment was performed in 69 patients with T2-4N0-1 (group 2). Survival, morbidity, and mortality rates were compared between the groups. Results: Sixty-two patients (53%) underwent left pneumonectomy. The median length of hospital stay was 6.4 days (range 1-33 days). Chemotherapy was administered in 29 patients (62%), and chemoradiotherapy in 18 patients (38%) preoperatively. Left pneumonectomy was performed in 29 patients after neoadjuvant treatment. Complications were detected in 31% of patients (group 1: 28%, group 2: 33%). Ninety-day mortality rate was 4.2% in group 1, and 5.8% in group 2. Five-year-survival rate was 41% and 35% for group 1 and group 2, respectively. Median survival time was 41 months and 40 months for group 1 and group 2, respectively. No statistically significant difference was detected between the two groups in terms of morbidity, mortality, and survival. Conclusion: This study showed that pneumonectomy after neoadjuvant treatment may be safely administered in patients with locally advanced NSCLC with acceptable morbidity, mortality, and survival rates.

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