P2.18-02 Pneumonectomy and Lung Cancer: A Treacherous Combination

Abstract

In spite of the progress made in recent years regarding minimally invasive and parenchymal-sparing surgery, pneumonectomy is still necessary in cases where lesser resections are not possible. However, pneumonectomy remains a high-risk surgical procedure associated with significant postoperative morbidity and mortality. We investigated early and long-term results in a recent series of patients undergoing pneumonectomy for lung cancer. Clinical and pathological characteristics of non-small cell lung cancer (NSCLC) patients treated by pneumonectomy between January 2008 and December 2013 were retrospectively reviewed. Overall 30- and 90-day mortality and 1-, 2-, and 5-year survival rates were calculated. Postoperative complications and disease progression or recurrence were analysed by descriptive statistics. Univariate and multivariate analyses of factors related to long-term survival were also performed. A total of 61 patients, 48 men and 13 women with an overall mean age of 64±8.9 years, underwent pneumonectomy. The 30- and 90-day mortality rates were 6.6% and 16.4%, respectively. Ninety-day mortality was significantly correlated to tumour pathology (p=0.0410) and occurrence of postoperative complications (p=0.0078). Overall 1-, 2-, and 5-year survival rates were 70.5%, 57.4%, and 37.7%, respectively. Progressive or recurrent disease occurred in 45.7% of all patients. Most frequent early complications were atrial fibrillation (41.0%), pneumonia (23.0%), and acute respiratory failure (18.3%). Despite careful patient selection, pneumonectomy yields high mortality and morbidity rates. Therefore, it should only be performed when no other therapeutic options are available. Furthermore, rigorous preoperative work-up and risk stratification models are necessary to determine whether pneumonectomy is the most suitable treatment option and to obtain acceptable long-term results.