The hypothesis that
chemotherapy increases morbidity after
pneumonectomy remains under debate, as the results of previous surgical series remain controversial. The hypothesis of the study is that patients who received preoperative
chemotherapy may have subclinical parenchymal damage, increasing their risk of respiratory complications.
METHODS: The study population was composed of 10 patients who underwent
pneumonectomy after
chemotherapy for
lung cancer (cisplatin+gemcitabine) randomly selected from our database and compared with 10 matched patients who underwent
pneumonectomy without previous
chemotherapy during the same period. Healthy lung tissue was obtained from surgical specimens, processed according to standard methods and evaluated on ematossilin and
eosin-stained sections. Two pathologists without information on the preoperative treatment were asked to review the slides in order to reach a consensus on the type and extent of lung damage. Relevant information was then compared with functional tests and postoperative outcome.
RESULTS: Severe and diffuse (more than 50% of lung parenchyma) interstitial alterations were detected in the lungs of eight patients, seven of which belonged to the
chemotherapy group (70%, p 0.02). Six of these patients developed postoperative respiratory complications. In the
chemotherapy group, patterns of interstitial involvement were variable interstitial
inflammation and
fibrosis associated with obliterative
bronchiolitis [Roberts JR, Eustis C, Devore R, et al.
Induction chemotherapy increases perioperative complications in patients undergoing resection for
non-small cell lung carcinoma. Ann Thorac Surg 2001;72:885-8],
bronchiolitis obliterans-organizing pneumonia [Leo F, Solli P, Veronesi G, et al. Does
chemotherapy increase the risk of respiratory complications after
pneumonectomy? J Thorac Cardiovasc Surg 2006;132:519-23], diffuse alveolar damage [Novoa N, Varela G, Jimenez MF. Morbidity after surgery for
non-small cell lung carcinoma is not related to
neoadjuvant chemotherapy. Eur J Cardiothor Surg 2001;20:700-4], DIP (desquamative
interstitial pneumonia)-like reaction [Roberts JR, Eustis C, Devore R, et al.
Induction chemotherapy increases perioperative complications in patients undergoing resection for
non-small cell lung carcinoma. Ann Thorac Surg 2001;72:885-8] and UIP (
usual interstitial pneumonia)-like changes [Roberts JR, Eustis C, Devore R, et al.
Induction chemotherapy increases perioperative complications in patients undergoing resection for
non-small cell lung carcinoma. Ann Thorac Surg 2001;72:885-8]. The only preoperative clinical predictor of severe diffuse damage was preoperative diffusion by
carbon monoxide (Dlco).
CONCLUSIONS: