AIM: To evaluate the outcomes of surgery for lung cancer after induction therapy.METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program(ACSNSQIP) database(2005-2012), we identified 4063 patients who underwent a pulmonary resection for lung cancer. Two hundred and thirty-six(5.8%) received neo-adjuvant therapy prior to surgery(64 chemo-radiation, 103 radiation alone, 69 chemotherapy alone). The outcomes were compared to 3827 patients(94.2%) treated with surgery alone. Primary outcome was 30-d mortality, and secondary outcomes included length of stay, operative time and NSQIP measured postoperative complications.RESULTS: Lung cancer patients who received preoperative treatment were younger(66 vs 69, P < 0.001), were more likely to have experienced recent weight loss(6.8% vs 3.5%; P = 0.011), to be active smokers(48.3 vs 34.9, P < 0.001), and had lower preoperative hematological cell counts(abnormal white blood cell: 25.6 vs 13.4; P < 0.001; low hematocrit 53% vs 17.3%, P < 0.001). On unadjusted analysis, neo-adjuvant patients had significantly higher 30-d mortality, overall and serious morbidity(all P < 0.001). Adjusted analysis showed similar findings, while matched cohorts comparison confirmed higher morbidity, but not higher early mortality.CONCLUSION: Our data suggest that patients who receive neo-adjuvant therapy for lung cancer have worse early surgical outcomes. Although NSQIP does not provide stage information, this analysis shows important findings that should be considered when selecting patients for induction treatment. AIM: To evaluate the outcomes of surgery for lung cancer after induction therapy. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP) database (2005-2012), we identified 4063 patients who underwent a pulmonary resection for lung cancer Two hundred and thirty-six (5.8%) received neo-adjuvant therapy prior to surgery (64 chemo-radiation, 103 radiation alone, 69 chemotherapy alone). The results were compared to 3827 patients (94.2%) treated with surgery alone. Primary outcome was 30-d mortality, and secondary results included length of stay, operative time and NSQIP measured postoperative complications. RESULTS: Lung cancer patients who received preoperative treatment were younger (66 vs 69, P <0.001), were more likely to have and had lower preoperative hematological cell counts (abnormal white blood cells: 25.6 vs 13.4; P & lt; 0.001, P <0.001); and recent lower weight loss (6.8% vs 3.5%; P = 0.011), to be active smokers (48.3 vs 34.9, low hema tocrit 53% vs 17.3%, P <0.001). On unadjusted analysis, neo-adjuvant patients had significantly higher 30-d mortality, overall and serious morbidity (all P <0.001). higher morbidity, but not higher early mortality. CONCLUSION: Our data suggest that patients who have neo-adjuvant therapy for lung cancer have worse early surgical outcomes. Although NSQIP does not provide stage information, this analysis shows important findings that should be considered when selecting patients for induction treatment.