Pneumonectomy Patients Research Articles

Lobectomy and pneumonectomy in patients over 70 years of age for the treatment of lung cancer: evaluation of surgical outcomes

Lobectomy and pneumonectomy in patients over 70 years of age for the treatment of lung cancer: evaluation of surgical outcomes

Variation in Hospital Mortality After Complex Cancer Surgery: Patient, Volume, Hospital or Social Determinants?

IntroductionWe sought to define the individual contributions of patient characteristics (PCs), hospital characteristics (HCs), case volume (CV), and social determinants of health (SDoH) on in-hospital mortality (IHM) after complex cancer surgery.MethodsThe California Department of Health Care Access and Information database identified patients who underwent esophagectomy (ES), pneumonectomy (PN), pancreatectomy (PD), or proctectomy (PR) for a malignant diagnosis between 2010 and 2020. Multi-level multivariable regression was performed to assess the proportion of variance explained by PCs, HCs, CV and SDoH on IHM.ResultsA total of 52,838 patients underwent cancer surgery (ES: n = 2,700, 5.1%; PN: n = 30,822, 58.3%; PD: n = 7530, 14.3%; PR: n = 11,786, 22.3%) across 294 hospitals. The IHM for the overall cohort was 1.7% and varied from 4.4% for ES to 0.8% for PR. On multivariable regression, PCs contributed the most to the variance in IHM (overall: 32.0%; ES: 21.6%; PN: 28.0%; PD: 20.3%; PR: 39.9%). Among the overall cohort, CV contributed 2.4%, HCs contributed 1.3%, and SDoH contributed 1.2% to the variation in IHM. CV was the second highest contributor to IHM among ES (5.3%), PN (5.3%), and PD (5.9%); however, HCs were a more important contributor among patients who underwent PR (8.0%). The unexplained variance in IHM was highest among ES (72.4%), followed by the PD (67.5%) and PN (64.6%) patient groups.ConclusionsPCs are the greatest underlying contributor to variations in IHM following cancer surgery. These data highlight the need to focus on optimizing patients and exploring unexplained sources of IHM to improve quality of surgical care.

Complex Sleeve Lobectomy Has Lower Postoperative Major Complications Than Pneumonectomy in Patients with Centrally Located Non-Small-Cell Lung Cancer.

Standard sleeve lobectomies are recommended over pneumonectomy (PN), but the efficacy and oncological proficiency of complex sleeve lobectomies (CSLs) have not been completely investigated. The aim of this study was to report our experience in CSL in patients affected by a centrally located non-small-cell lung cancer (NSCLC), comparing all the variables and outcomes with PN. From 2014 to 2022, we collected the data of patients who underwent PN and CSL for NSCLC, excluding neuroendocrine tumors, salvage surgery or carinal resection. Regression analysis was used to assess the association between procedures and complications; the Kaplan-Meier method and Cox regression analysis were used to evaluate survival and risk factors of reduced survival. We analyzed n = 38 extended sleeve lobectomies and n= 6 double-sleeve lobectomies (CSL group) and n= 60 PNs. We had a trend toward higher postoperative mortality in the PN group (5% vs. 0%, p = 0.13). Major complications and bronchial fistula developed in 21.7% and 6.8% (p = 0.038) and in 6.7% and 4.5% (p = 0.64), respectively. The right side was identified as risk factor for major complications, whereas age > 70 and PN had a trend of association in multivariable analysis. The median OS was similar between the two groups (p = 0.76) and cancer recurrence was the only significant risk factors of reduced OS. Excluding functionally compromised patients, the OS of CSL was better than that of PN (67% vs. 42%, p = 0.25). Considering that major complications are often associated with mortality after surgery for centrally located NSCLC, CSLs could be considered an alternative to PN while also ensuring comparable survival.

Respect the Middle Lobe: Perioperative Risk of Bilobectomy Compared With Lobectomy and Pneumonectomy

BackgroundIn some cases of right-sided lung cancer, tumor extension, bronchial involvement, or pulmonary artery infiltration may necessitate bilobectomy. Although the middle lobe is believed to represent a fraction of total lung function, the morbidity and mortality associated with bilobectomy is not well described. MethodsWe retrospectively identified patients in The Society of Thoracic Surgeons Database who underwent lobectomy, bilobectomy, or pneumonectomy for lung cancer from 2009 to 2017. The primary outcome was 30-day perioperative mortality. We performed propensity matching by patient demographics, comorbidities, and perioperative variables for each surgical type against bilobectomy and ran Cox proportional hazard models. Secondary outcomes of 30-day morbidity and mortality of upper vs lower bilobectomy were also compared. ResultsWithin the study period 2911 bilobectomy, 65,506 lobectomy, and 3370 pneumonectomy patients met the inclusion criteria. Patients undergoing pneumonectomy and bilobectomy had fewer comorbidities than lobectomy patients. After propensity matching 30-day mortality of bilobectomy was comparable with left pneumonectomy (hazard ratio [HR], 1.35; 95% CI, 0.95-1.91; P = .09) and significantly worse than left (HR, 0.40; 95% CI, 0.29-0.56; P < .0001) or right (HR, 0.43; 95% CI, 0.31-0.59; P < .0001) lobectomy. Bilobectomy was associated with a survival advantage compared with right pneumonectomy (HR, 2.54; 95% CI, 1.72-3.74; P < .0001). Thirty-day morbidity was higher for bilobectomy compared with lobectomy, and upper bilobectomy had a significant unadjusted 30-day mortality advantage compared with lower bilobectomy (98.3% vs 97%, P = .04). ConclusionsThe morbidity and mortality of bilobectomy is significantly worse than lobectomy and is comparable with left pneumonectomy. The addition of middle lobectomy to a pulmonary resection is not without risk and should be carefully considered during preoperative risk stratification.

Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients.

Some patients with non-small cell lung cancer (NSCLC) have superior short- and long-term outcomes with sleeve lobectomy rather than pneumonectomy. Originally sleeve lobectomy was reserved for patients with limited pulmonary function, however, the reported superior results allowed sleeve lobectomy to be performed in expanded patient populations. In a further attempt to improve post-operative outcomes surgeons have adopted minimally invasive techniques Minimally invasive approaches have potential benefits to patients such as decreased morbidity and mortality while maintaining the same caliber of oncologic outcomes. We identified patients at our institution who underwent sleeve lobectomy or pneumonectomy to treat NSCLC from 2007 to 2017. We analyzed these groups in respect to 30- and 90-day mortality, complications, local recurrence, and median survival. We included multivariate analysis to determine the impact of a minimally invasive approach, sex, extent of resection, and histology. Differences in mortality were analyzed using the Kaplan-Meier method using the log-rank test to compare the groups. A two-tailed Z test for difference in proportions was done to analyze complications, local recurrence, 30-day and 90-day mortality. A total of 108 patients underwent sleeve lobectomy (n=34) or pneumonectomy (n=74) for treatment of NSCLC with 18 undergoing open pneumonectomy, 56 undergoing video-assisted thoracoscopic surgery (VATS) pneumonectomy, 29 undergoing open sleeve lobectomy, and 5 undergoing VATS sleeve lobectomy. There was no significant difference in 30-day mortality (P=0.064) but there was a difference in 90-day (P=0.007). There was no difference in complication rates (P=0.234) or local recurrence rates (P=0.779). The pneumonectomy patients had a median survival of 23.6 months (95% CI: 3.8-43.4 months). The sleeve lobectomy group had a median survival of 60.7 months (95% CI: 43.3-78.2 months) (P=0.008). On multivariate analysis extent of resection (P<0.001) and tumor stage (P=0.036) were associated with survival. There was no significant difference between the VATS approach and the open surgical approach (P=0.053). When considering patients undergoing surgery for NSCLC sleeve lobectomy resulted in lower 90-day mortality and better 3-year survival compared to patients undergoing PN. Having a sleeve lobectomy rather than a pneumonectomy and having earlier-stage disease lead to significantly improved survival on multivariate analysis. Having a VATS operation leads to a non-inferior post-operative outcome compared to open surgery.

Bronchial stump protective ventilator strategy with low positive end expiratory pressure in post pneumonectomy patient

Bronchial stump protective ventilator strategy with low positive end expiratory pressure in post pneumonectomy patient - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/j.ijca.2023.021, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Outcomes and pulmonary function after sleeve lobectomy compared with pneumonectomy in patients with non-small cell lung cancer.

Sleeve lobectomy is recommended to avoid pneumonectomy and preserve pulmonary function in patients with central lung cancer. However, the relationship between postoperative pulmonary functional loss and resected lung parenchyma volume has not been fully characterized. The aim of this study was to evaluate the relationship between pulmonary function and lung volume in patients undergoing sleeve lobectomy or pneumonectomy. A total of 61 lung cancer patients who had undergone pneumonectomy or sleeve lobectomy were analyzed retrospectively. Among them, 20 patients performed pulmonary function tests, including vital capacity (VC) and forced expiratory volume in 1 s (FEV1) tests, preoperatively and then about 6months after surgery. VC and FEV1 ratios were calculated (measured postoperative respiratory function/predicted postoperative respiratory function) as the standardized pulmonary functional loss ratio. Thirty-day operation-related mortality was significantly lower after sleeve lobectomy (3.2%) than pneumonectomy (9.6%). The 5-year relapse-free survival rate was 46.67% versus 29.03%, and the 5-year overall survival rate was 63.33% versus 38.71% in patients receiving sleeve lobectomy versus pneumonectomy. The VC ratio in the pneumonectomy group was better than in the sleeve lobectomy group (1.003 ± 0.117 vs. 0.779 ± 0.12; p=0.0008), as was the FEV1 ratio (1.132 ± 0.226 vs. 0.851 ± 0.063; p=0.0038). Both short-term and long-term outcomes were better with sleeve lobectomy than pneumonectomy. However, actual postoperative pulmonary function after pneumonectomy may be better than clinicians expect, and pneumonectomy should still be considered a treatment option for patients with sufficient pulmonary reserve and in whom sleeve lobectomy is less likely to be curative.

EP06.01-007 Fate of Pneumonectomy Patients During Covid-19 Pandemic

IntroductionThe best treatment modality for lung cancer patients relies on survival estimates to weigh risks and benefits of treatments. However, patients who had pneumonectomy may have inherent oncologic or physiologic survival challanges. We aimed to analyzed the physiologic and survivability consequences of COVID-19 in these patients.MethodsA total of 111 of 898 patients(12.3%) who underwent resection in our clinic between 2001-2021 underwent pneumonectomy. Data of 70 patients were completed and the remaining 41 patients were excluded from the study for various reasons. The patients' survival, daily physical activities, comparison of preoperative and postoperative physical activity, and the general condition of those who had COVID-19 were questioned.ResultsSixty-seven patients were male (95.7%), three patients were female (4.3%). Forty patients (57.14%) had left pneumonectomy whereas 30 patients (42.85%) had right pneumonectomy. While 26 people (37.1%) were alive, 44 patients (62.9%) died. Four patients were suffered from COVID-19 infection and two of them died. Mortality was 50.0% whereas 1 (3.8%) and 2 (7.7%) patients had had extremely poorer and poorer physical activity compared to those of before pneumonectomy respectively, 9 patients (34.6%), 10 (38.5%) and 4 (15.4%) had same, better and extremely better physical activity compared to those of prior to pneumonectomy respectively. Estimated survival of all patients was 106 months (at the (95% confidence interval [CI]:58.69-153.30 months). The median survival of patients with right pneumonectomy was 103 months (95% CI:56.0-150.0 months) whereas it was 110 months (95% CI:45.5-174.5 months) in patients who had left pneumonectomy (p=0.859).ConclusionsView Large Image Figure ViewerDownload Hi-res image Download (PPT)KeywordsCovid-19, Pneumonectomy, Quality of Life IntroductionThe best treatment modality for lung cancer patients relies on survival estimates to weigh risks and benefits of treatments. However, patients who had pneumonectomy may have inherent oncologic or physiologic survival challanges. We aimed to analyzed the physiologic and survivability consequences of COVID-19 in these patients. The best treatment modality for lung cancer patients relies on survival estimates to weigh risks and benefits of treatments. However, patients who had pneumonectomy may have inherent oncologic or physiologic survival challanges. We aimed to analyzed the physiologic and survivability consequences of COVID-19 in these patients. MethodsA total of 111 of 898 patients(12.3%) who underwent resection in our clinic between 2001-2021 underwent pneumonectomy. Data of 70 patients were completed and the remaining 41 patients were excluded from the study for various reasons. The patients' survival, daily physical activities, comparison of preoperative and postoperative physical activity, and the general condition of those who had COVID-19 were questioned. A total of 111 of 898 patients(12.3%) who underwent resection in our clinic between 2001-2021 underwent pneumonectomy. Data of 70 patients were completed and the remaining 41 patients were excluded from the study for various reasons. The patients' survival, daily physical activities, comparison of preoperative and postoperative physical activity, and the general condition of those who had COVID-19 were questioned. ResultsSixty-seven patients were male (95.7%), three patients were female (4.3%). Forty patients (57.14%) had left pneumonectomy whereas 30 patients (42.85%) had right pneumonectomy. While 26 people (37.1%) were alive, 44 patients (62.9%) died. Four patients were suffered from COVID-19 infection and two of them died. Mortality was 50.0% whereas 1 (3.8%) and 2 (7.7%) patients had had extremely poorer and poorer physical activity compared to those of before pneumonectomy respectively, 9 patients (34.6%), 10 (38.5%) and 4 (15.4%) had same, better and extremely better physical activity compared to those of prior to pneumonectomy respectively. Estimated survival of all patients was 106 months (at the (95% confidence interval [CI]:58.69-153.30 months). The median survival of patients with right pneumonectomy was 103 months (95% CI:56.0-150.0 months) whereas it was 110 months (95% CI:45.5-174.5 months) in patients who had left pneumonectomy (p=0.859). Sixty-seven patients were male (95.7%), three patients were female (4.3%). Forty patients (57.14%) had left pneumonectomy whereas 30 patients (42.85%) had right pneumonectomy. While 26 people (37.1%) were alive, 44 patients (62.9%) died. Four patients were suffered from COVID-19 infection and two of them died. Mortality was 50.0% whereas 1 (3.8%) and 2 (7.7%) patients had had extremely poorer and poorer physical activity compared to those of before pneumonectomy respectively, 9 patients (34.6%), 10 (38.5%) and 4 (15.4%) had same, better and extremely better physical activity compared to those of prior to pneumonectomy respectively. Estimated survival of all patients was 106 months (at the (95% confidence interval [CI]:58.69-153.30 months). The median survival of patients with right pneumonectomy was 103 months (95% CI:56.0-150.0 months) whereas it was 110 months (95% CI:45.5-174.5 months) in patients who had left pneumonectomy (p=0.859). Conclusions KeywordsCovid-19, Pneumonectomy, Quality of Life Covid-19, Pneumonectomy, Quality of Life

109MO Respect the middle lobe: Perioperative survival of bilobectomy compared to lobectomy and pneumonectomy

In some cases of right-sided lung cancer, tumor extension, bronchial involvement, or pulmonary artery infiltration may necessitate bilobectomy. Although the middle lobe is thought to represent only a small fraction of the total right lung function, the morbidity and mortality associated with bilobectomy in comparison to other pulmonary resections is not well described. We retrospectively identified patients in the Society for Thoracic Surgeons General Thoracic Surgery Database who underwent elective lobectomy, bilobectomy, or pneumonectomy for lung cancer from 2009 to 2017, excluding reoperations. The primary outcome was 30-day perioperative mortality. Cox proportional hazards were calculated after adjusting for patient demographics, comorbidities, and perioperative variables. Secondary outcomes included 30-day morbidity, mortality of upper versus lower bilobectomy, and rate of nodal upstaging or downstaging. Within the study period, 2,911 bilobectomy, 65,506 lobectomy, and 3,024 pneumonectomy patients met inclusion criteria. Patients undergoing pneumonectomy and bilobectomy had fewer comorbidities than lobectomy patients. Both unadjusted and adjusted 30-day mortality of bilobectomy were comparable to a left pneumonectomy, which was worse than left or right lobectomy but better than right pneumonectomy (Table). Bilobectomy had consistently worse 30-day morbidity than lobectomy. Upper bilobectomy had a small but significant unadjusted 30-day survival advantage compared to lower bilobectomy (98.3% vs 97%, log-rank p=0.04). Nodal upstaging of bilobectomy (22.8%) fell between that of lobectomy and pneumonectomy.Table: 109MOAdjusted 30-day Cox proportional hazards and absolute mortalityCox proportional hazardHR95% CIpAbsolute mortalityBilobectomyref--2.6%Left lobectomy0.440.34-0.56<0.00011.0%Right lobectomy0.470.36-0.60<0.00011.1%Left pneumonectomy1.320.95-1.850.103.5%Right pneumonectomy2.762.01-3.81<0.00017.0% Open table in a new tab The morbidity and mortality of bilobectomy is significantly worse than lobectomy and is comparable to the outcomes of left pneumonectomy. The addition of middle lobectomy to a pulmonary resection is not without risk and should be carefully considered during pre-operative risk stratification.

СОВРЕМЕННЫЕ ПОДХОДЫ К ОБРАБОТКЕ КУЛЬТИ ГЛАВНОГО БРОНХА ПРИ ПНЕВМОНЭКТОМИИ У БОЛЬНЫХ С РАСПРОСТРАНЕННЫМ ДЕСТРУКТИВНЫМ ТУБЕРКУЛЕЗОМ ЛЕГКИХ

Bronchopleural complications are considered to be the most important and most common causes of treatment failure, and in some cases – causes of fatal outcomes of surgical treatment of tuberculosis (TB). Formation of a bronchopleural fistula (BPF) remains the most severe complication of lung resection and, particularly, pneumonectomy. The purpose of this literature review is to highlight modern approaches to treatment of the main bronchus stump during pneumonectomy in patients with advanced destructive pulmonary TB.

UniPortal thoracoscopic pneumonectomy does not compromise perioperative and long-term survival in patients with NSCLC: A retrospective, multicenter, and propensity score matching study

ObjectivesTo compare the perioperative and oncologic outcomes following pneumonectomy performed by uniportal video-assisted thoracoscopic surgery (U-VATS) and thoracotomy in patients with centrally located non–small cell lung cancer (NSCLC). Materials and methodsPatients with NSCLC who underwent pneumonectomy at the Shanghai Pulmonary Hospital (SPH) and Sun Yat-sen University Cancer Center (SYUCC) with the U-VATS approach or open approach between 2011 and 2016 were selected. Propensity score matching (1:3) was performed to balance the baseline covariates. Overall survival (OS) rates and recurrence-free survival (RFS) rates were estimated and compared using the Kaplan–Meier method, respectively. ResultsThe enrollees in the study were 579 patients in the SPH cohort, with 501 (86.5%) in the open group and 48 (13.5%) in the U-VATS group, and 271 patients in the SYUCC cohort, with 245 (90.4%) in the open group and 26 (9.6%) in the U-VATS group. After propensity score matching, morbidity rates and 30-day mortality rates were found to be similar between the U-VATS group and open group in both the SPH and SYUCC cohorts. The long-term OS rate of patients who underwent U-VATS pneumonectomy did not significantly differ compared with the patients who underwent open pneumonectomy in both cohorts (SPH, p = .900; SYUCC, p = .240). Cox regression analysis revealed that the surgical option was not a risk factor for the OS rate (SPH: hazard ratio [HR], 0.925; 95% confidence interval [CI], 0.555 to 1.542; SYUCC: HR, 1.524; 95% CI, 0.752 to 3.087). ConclusionU-VATS can be used to safely perform pneumonectomy in patients with centrally located NSCLC without compromising the perioperative and oncologic outcomes compared with an open approach.

Indications and outcomes of pneumonectomy for benign diseases: A single-center experience

Background: Pneumonectomy can be used to manage destroyed lung; however, it is associated with a high risk of complications. This study analyzed the outcomes of pneumonectomy in patients with destroyed lungs.&#x0D; Methods: The study included 28 patients who had pneumonectomy for benign lung diseases from January 2011 to December 2017. Descriptive analysis was used to present patients' demographics, surgical details, and postoperative outcomes. Intraoperative blood loss was compared in tuberculous vs. non-tuberculous patients and those who had extrapleural vs. intrapleural pneumonectomy.&#x0D; Results: The study included 11 (39%) males, and the mean age was 36.6 ± 9.8 years (range: 5– 61). The persistent cough was the presenting symptom in 93% of cases, expectoration in 78.6%, hemoptysis in 46.4%, and chest pain in 28.6% of patients. Indications for pneumonectomy were tuberculosis in 13 (46.4%), septic bronchiectasis in 10 (35.7%), invasive opportunistic infections in 3 (10.7%), neglected endobronchial foreign body in 1 (3.6%), and neglected rupture bronchus in 1 (3.6%) patient. Pneumonectomy was left-sided in 21 (75%) patients. We performed extrapleural pneumonectomy in 7 (25%) patients, intra-pericardial isolation in 5 (17.9%) patients, and two patients (7.2%) had completion pneumonectomy. Mean perioperative bleeding was 390.7± 233.8 ml. The intraoperative blood loss was more in patients with tuberculosis and extrapleural pneumonectomy (P&lt; 0.05). Postoperative complications occurred in 7 patients (25%), and we reported one operative mortality. &#x0D; Conclusions: Pneumonectomy for benign lung disease is a challenging procedure. Destroyed lung due to TB and bronchiectasis are the most common indications. The outcome could be improved with careful patient selection, appropriate preoperative preparation, meticulous operative techniques, and high postoperative care standards.

Comparison of Bronchial Sleeve Lobectomy With Pulmonary Arterioplasty Versus Pneumonectomy

BackgroundThis study evaluated the efficacy of bronchial sleeve lobectomy with pulmonary arterioplasty compared with pneumonectomy in centrally located non-small cell lung cancer with bronchovascular invasion. MethodsThe cohort consisted of 212 patients receiving pneumonectomy and 156 patients undergoing bronchial sleeve lobectomy with pulmonary arterioplasty. Propensity score matching was used to create a fully balanced cohort, after which, baseline characteristics, perioperative performance, and oncologic results were compared between the 2 groups. ResultsA total of 139 pneumonectomy patients were matched with 139 sleeve lobectomy patients. In the matched cohort, bronchial sleeve lobectomy with pulmonary arterioplasty was associated with longer operative time (P < .001), decreased perioperative transfusion rate (P = .002), shorter postoperative hospital stays (P < .001), shorter intensive care unit stays (P = .040), and lower Clavien-Dindo Classification (P = .016). In respect to survival outcomes, a log-rank test revealed no significant difference in overall survival (P = .381) and recurrence-free survival (P = .619) between the 2 surgical procedures. ConclusionsBronchial sleeve lobectomy with pulmonary arterioplasty could achieve superior perioperative outcomes and equivalent oncologic efficacy compared with pneumonectomy, indicating that this complex procedure is safe and reliable for centrally located non-small cell lung cancer concurrently involving the pulmonary artery and bronchus.

Drug Regimen for Patients after a Pneumonectomy

Pneumonectomy is an entire lung removal and is indicated for both malignant and benign diseases. Due to its invasiveness and postoperative complications, pneumonectomy is still associated with high mortality and morbidity. Appropriate postoperative management is crucial in pneumonectomy patients to improve quality of life and overall survival rates. Diverse drug regimens are under development to be used in adjuvant chemotherapy or to improve respiratory health after a pneumonectomy. The most common causes for a pneumonectomy are non-small cell lung cancer, malignant pleural mesothelioma, and tuberculosis; thus, an appropriate drug regimen is necessary. The uncommon incidence of pneumonectomy cases remains the major obstacle in studies of postoperative drug regimens. As the majority of current studies include post-lobectomy and post-segmentectomy patients, it is highly recommended that further research of postoperative drug regimens be focused on post-pneumonectomy patients.

Evaluation of different treatment strategies between right-sided and left-sided pneumonectomy for stage I-IIIA non-small cell lung cancer patients.

BackgroundThis study aimed to assess the different survival outcomes of stage I–IIIA non-small cell lung cancer (NSCLC) patients who received right-sided and left-sided pneumonectomy, and to further develop the most appropriate treatment strategies.MethodsWe accessed data from the Surveillance, Epidemiology, and End Results database from the United States for the present study. An innovative propensity score matching analysis was used to minimize the variance between groups.ResultsFor 2,683 patients who received pneumonectomy, cancer-specific survival [hazard ratio (HR) =0.863, 95% confidence interval (CI): 0.771 to 0.965, P=0.010] and overall survival (OS; HR =0.875, 95% CI: 0.793 to 0.967, P=0.008) were significantly superior in left-sided pneumonectomy patients compared with right-sided pneumonectomy patients. Cancer-specific survival (HR =0.847, 95% CI: 0.745 to 0.963, P=0.011) and OS (HR =0.858, 95% CI: 0.768 to 0.959, P=0.007) were also significantly longer with left-sided compared to right-sided pneumonectomy after matching analysis of 2,050 patients. Adjuvant therapy could significantly prolong cancer-specific survival (67 versus 51 months, HR =1.314, 95% CI: 1.093 to 1.579, P=0.004) and OS (46 versus 30 months, HR =1.458, 95% CI: 1.239 to 1.715, P<0.001) among left-sided pneumonectomy patients after the matching procedure, while adjuvant therapy did not increase cancer-specific survival for right-sided pneumonectomy patients (46 versus 42 months, HR =1.112, 95% CI: 0.933 to 1.325, P=0.236). Subgroup analysis showed that adjuvant chemotherapy could significantly improve cancer-specific survival and OS for all pneumonectomy patients. However, radiotherapy was associated with worse survival for patients with right-sided pneumonectomy.ConclusionsPneumonectomy side can be deemed as an important factor when physicians determine the most optimal treatment strategies.

Postoperative atrial fibrillation in pneumonectomy for primary lung cancer.

BackgroundThis study assessed the incidence and risk factors (RFs) of postoperative atrial fibrillation (POAF) and its impact on clinical outcomes in patients undergoing pneumonectomy for lung cancer.MethodsBetween 2013 and 2018, this monocentric retrospective study enrolled 324 consecutive pneumonectomy patients for primary lung cancer from our institution and 350 lobectomy and 349 segmentectomy cases matched by age, sex and body mass index (BMI). RF for POAF and postoperative death in pneumonectomy patients were assessed by logistic regression, and long-term outcomes after a median follow-up of 30 (range, 2–61) months by Cox proportional hazard model. Electrophysiology study (EPS) files of 30 AF patients with lung resection history were reviewed.ResultsPOAF developed more often after pneumonectomy than lobectomy and segmentectomy (23.2% vs. 6.6% vs. 1.4%, respectively; P<0.001). Among 75 pneumonectomy patients with POAF, POAF was solitary in 55 patients (73.3%) and concurrent with other complications in 3 patients (4%). POAF risk after pneumonectomy was 4 and 22 times that after lobectomy and segmentectomy, respectively, with age >60 years and left atrial diameter (LAd) ≥35 mm as independent predictors. POAF, infection and hemorrhage were independent RFs for perioperative death after pneumonectomy; however, POAF was not RF for long-term death. Pulmonary vein (PV) trigger was identified in 60% (18/30) of AF patients with lung resection history, with stump PVs being more active than non-stump PVs (38.2% vs. 10.5%, P<0.001).ConclusionsPost-pneumonectomy AF, with remarkable incidence, risk and independent predictors including age >60 years and LAd ≥35 mm, was mostly solitary and possibly secondary to stump and non-stump PV triggers. POAF, along with infection and hemorrhage, was a RF for perioperative death.

Propensity-matched Analysis Demonstrates Long-term Risk of Respiratory and Cardiac Mortality After Pneumonectomy Compared With Lobectomy for Lung Cancer.

We sought to quantify and characterize long-term consequences of pneumonectomy, with particular attention to nononcologic mortality. Pneumonectomy is associated with profound changes in cardiopulmonary physiology. Studies of long-term outcomes after pneumonectomy typically report generalized measures, such as disease-free and overall survival. Patients undergoing lobectomy or pneumonectomy for lung cancer at our institution from 2000 to 2018 were reviewed. Propensity-score matching was performed for 12 clinicopathologic factors. Ninety-day complications and deaths were compared. Five-year cumulative incidence of oncologic and nononcologic mortality were compared using competing risks approaches. From 3339 lobectomy and 355 pneumonectomy patients identified, we derived 318 matched pairs. At 90 days, rates of overall complications were similar (46% for pneumonectomy vs 43% for lobectomy; P = 0.40), but rates of major complications (21% vs 13%; P = 0.005) and deaths (6.9% vs 1.9%; P = 0.002) were higher the pneumonectomy cohort. The cumulative incidence of oncologic mortality was not significantly different between cohorts (P = 0.9584). However, the cumulative incidence of nononcologic mortality was substantially higher in the pneumonectomy cohort for both date of surgery and 1-year landmark analyses (P < 0.0001 and P = 0.0002, respectively). Forty-five pneumonectomy patients (18%) died of nononcologic causes 1-5 years after surgery; pneumonia (n = 21) and myocardial infarction (n = 10) were the most common causes. In pneumonectomy patients, preexisting cardiac comorbidity and low diffusion capacity of the lungs for carbon monoxide were predictive of nononcologic mortality. Compared to lobectomy, excess mortality after pneumonectomy extends beyond 1 year and is driven primarily by nononcologic causes. Pneumonectomy patients require lifelong monitoring and may benefit from expeditious assessment and intervention at the initial signs of illness.

Опыт применения пластики переднего средостения во время пневмонэктомии у больных с распространенным деструктивным туберкулезом легких*

Опыт применения пластики переднего средостения во время пневмонэктомии у больных с распространенным деструктивным туберкулезом легких*

Evaluation of factors affecting morbidity and mortality in pneumonectomy patients

Background The aim of this study was to evaluate risk factors associated with morbidity and mortality after pneumonectomy in non-small cell lung cancer patients. Methods The study included 107 patients who underwent pneumonectomy for non-small cell lung cancer between January 2013 and December 2018. Prognostic factors affecting mortality and morbidity were investigated. Results The patient group included 10 women (9.3%) and 97 men (90.7%) with a mean age of 59.5 ± 8.5 years. Seventy-three patients (68.2%) underwent standard pneumonectomy and 34 (31.8%) underwent extended pneumonectomy. Nine patients (8.4%) received induction chemotherapy. Complications occurred in 33 patients (30.8%). Complications were classified as surgical, cardiovascular, pulmonary, or infectious. Charlson Comorbidity Index (CCI) > 3 and right-side resection were significant risk factors for the development of complications. The most common complication was atrial fibrillation. Eleven patients developed a bronchopleural fistula. The 30-day postoperative mortality rate was 6.5% (n = 7). Mortality was not associated with any demographic and surgical characteristics other than CCI > 3 (p = .05). Conclusion The results of this study indicate that our pneumonectomy outcomes are acceptable despite high morbidity and mortality rates. Appropriate patient selection for pneumonectomy is as important as complication management. High-comorbidity patients should undergo these procedures in experienced centers.

Management of medical complications after pneumonectomy

Pneumonectomy is still a surgical alternative for some patients with advanced non-small cell lung cancer. However, it is associated with a significant incidence of perioperative morbidity and mortality, far higher than other pulmonary resections, and therefore should only be considered when a more conservative resection is not technically feasible or oncologically adequate. Careful preoperative evaluation of patients’ functional status is mandatory and stringent postoperative care with early diagnosis and appropriate management is crucial to minimize the risk of medical complications, to reduce mortality, and to improve quality of life of pneumonectomy patients.