Outcomes Of Pneumonectomy Research Articles

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.

Safe pneumonectomy for locally advanced lung cancer after induction therapy.

To assess the safety and long-term outcomes of pneumonectomy after IT (IT-Pn) versus upfront pneumonectomy without IT (U-Pn) for locally advanced non-small-cell lung cancer (NSCLC). We reviewed the clinical records of 69 patients who underwent pneumonectomy as U-Pn (n = 30) or IT-Pn (n = 39) between 2000 and 2019 at our institution, RESULTS: U-Pn included patients with pathological N0 (n = 13), N1 (n = 11) and N2 (n = 6). Among the patients treated with IT-Pn, 18 had pathological N0 (including 7 with complete responses), 5 had N1, 14 had N2, and 2 had N3. It was suggested that 22 cases could be down-staged after IT. The 5-year overall survival (OS) was 28.1% in the U-Pn group and 43.1% in the IT-Pn group (p = 0.275), being 40.2% for IT-Pn with p-N2,3, but not reached for U-Pn with N2 (p = 0.307). The 90-day mortality was 6.7% for the U-Pn group and 5.1% for the IT-Pn group (p = 0.646). Major complications occurred in 25 patients (64.1%) treated with IT-Pn and 18 patients treated with U-Pn (60.0%; p = 0.602). Pneumonectomy for NSCLC can be performed safely after IT with favorable results. For patients with N2 disease, induction therapy followed by surgery may warrant further study.

372 Short- And Long-Term Outcome of Pneumonectomy for Lung Cancer: 20 Years’ Experience of a Single Centre

Abstract Introduction Surgery is the most important therapeutic modality for the treatment of primary lung cancer. Studies normally reported as 30-days or 90-days post-operative mortality or 5-years survival. However, survival for ≥10-years is rarely mentioned. Method Retrospective data collection from a tertiary centre database was implemented which include patients who underwent pneumonectomy from January 1998 until November 2019. The data was analysed for short and long-term outcomes including their respective Thoracoscore. Results 268 patients who had pneumonectomy were selected, in majority for lung cancer. 79.1% were male with mean age is 63. Overall operative mortality in this cohort was 4.9% while reported national mortality for pneumonectomy for lung cancer is 7%. No 30-days post-operative mortality in the last 5 years. The 5,10- and 15-years survival rate for patients are 36.9%, 23.9% and 20.3% respectively. This showed significant increase in the survival rate for 5- and 10-years post-pneumonectomy in comparison to previous study. Long-term survival was better in female with age &amp;lt;70 years. The overall survival rate &amp;gt;15 years is 0.4%. Conclusions This study shows that our operative mortality for pneumonectomy is significantly lower (30% less) than national mortality. This confirms that pneumonectomy is still an effective modality in the treatment of lung cancer.

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.

Survival outcomes of pneumonectomy with left atrial resection for non-small cell lung cancer.

Lung cancer invading left atrium is accepted as T4 tumor and surgical treatment in this situation is controversial. The aim of our study was to determine the prognostic factors of patients with surgically treated non-small cell lung cancer (NSCLC) invading left atrium. After the approval of local ethics committee, the study was conducted in Gazi University, Department of Thoracic Surgery (Ankara-Turkey). The records of the patients were obtained from the encrypted hospital management software. Sequential codes were given to the data of patients and it was transferred to the statistics program without their names and ID numbers. The data of patients were collected as follows: those who had extended pneumonectomy from the surgery reports were found, then their pathology reports were examined, and those who had atrial muscle tissue were included in the study. Selected cases included as follows: patients who were medically suitable for surgery, patients who could tolerate surgery in cardiology evaluation, patients who had adequate lung capacity for pneumonectomy. Data of patients were analyzed according to age, gender, lymph node invasion, complete resection, and operative mortality. A total of 18 patients were included in the study. There were 16 (88.8%) men and 2 (12.2%) women. The mean age was 60.8 (range: 44 -76; Standard deviation: ± 1.8) years. Cardiopulmonary bypass was used in only one patient. The 30-day mortality was 5.5%. 1, 3, and 5-years overall survivals were 77%, 18.6%, and 9.3%, respectively. Mediastinal lymph node metastasis in N1 and N2 stations was detected 10 and 2, respectively. There was statistically significant correlation between recurrence and lymph node invasion status including N1 and N2 station (P = 0.04). ">Although surgery is controversial in patients with NSCLC invading left atrium, it can be performed in selected cases. Morbidity and mortality rates were acceptable.

Primary pneumonectomy, pneumonectomy after induction therapy, and salvage pneumonectomy: a comparison of surgical and prognostic outcomes.

BackgroundSurgical outcomes of pneumonectomy for lung cancer differ based on various therapeutic strategies.MethodsOne hundred and fifty-one patients who underwent pneumonectomy were divided into three groups based on patients’ therapeutic conditions: a primary pneumonectomy group (no preoperative treatment, n=137), an induction group (planned surgery after induction chemotherapy or chemoradiotherapy, n=10), and a salvage group (surgery for residual or enlarged lesions after radical non-operative therapies, n=4).ResultsMultivariate analysis showed that completeness of resection (P=0.003), subcategorization of whether there was no invasion, infiltration only to the main bronchus or pleura, or invasion of other deeper structures (P=0.008), and the presence or absence of mediastinal lymph node metastasis (P=0.033) were significant prognostic factors. Severe postoperative complications occurred in 5.1% (7/137), 20% (2/10), and 0% (0/4) in the primary pneumonectomy, induction, and salvage groups, respectively. Among patients with pN0-1 disease, the 3-year overall survival rate was 58.7% in the primary pneumonectomy group, 100% and 40% in cases with high and low pathological effects in the induction group, respectively, and 50% in the salvage group. Among patients with pN2 disease, this rate was 41.4% in the primary pneumonectomy group, and no patients survived for postoperative 2 years in the other groups.ConclusionsFor patients undergoing pneumonectomy, subcategorization based on the invasion status (none/bronchus/pleura or other deeper structures) is a crucial prognostic factor. To consider pneumonectomy in the induction or salvage setting, selecting patients with pN0-1 disease may be mandatory.

Discussion

Dr Thomas A. D'Amico (Durham, NC). The role of pneumonectomy continues to evolve, and the outcomes of pneumonectomy are more dependent on the physiologic status of the patient, use of induction therapy, failure to rescue, need for readmission, and surgeon and center experiences than all other important surgical oncology procedures. In addition, the decision to perform pneumonectomy is one of the most difficult and important. Although the morbidity and mortality are higher than for other procedures, patients who need pneumonectomy are significantly less likely to benefit from systemic therapy and radiation therapy alone.

Pneumonectomy for lung metastases: the role in the modern era

Lung metastasectomy is considered worldwide as part of multimodal treatment for selected oligometastatic patients. Wedge resection is the most common approach performed with lung-sparing intent and, even if anatomical resections like segmentectomies or even lobectomies can be accepted, the role of pneumonectomy has always been debated and progressively discouraged due to the perceived high morbidity and mortality rates compared with its uncertain oncological benefits. A retrospective review and analysis of patients underwent pneumonectomy for lung metastases conducted in our center from January 1995 to December 2017 showed that on a total of 832 pneumonectomies performed, only 17 (2%) were conducted to resect pulmonary metastases and above all, only two patients were operated in the last decade. This revealed the tendency to progressively abandon the use of pneumonectomy to treat pulmonary metastasis. Indications and outcomes of pneumonectomy to resect pulmonary metastases are illustrated along with the speculative reasons of the decrease in the use of this therapeutic tool. The latter include a better patient selection due to the improved understanding of the oligometastatic disease, major improvements in the efficiency and tolerance of systemic therapies and the availability of alternative techniques for the local treatment of secondary lung lesions. Nevertheless, the limited benefit in terms of long-term survival and the relative high morbidity and mortality should not exclude a priori from considering pneumonectomy with curative intent for locally-advanced metastatic disease. A tiny role for this option is likely to remain in the therapeutic armamentarium for highly selected patients with isolated resectable pulmonary metastases undergoing a multidisciplinary management when no other alternatives are available.

Pneumonectomy for Pediatric Tumors-a Pediatric Surgical Oncology Research Collaborative Study.

To describe utilization and long-term outcomes of pneumonectomy in children and adolescents with cancer. Pneumonectomy in adults is associated with significant morbidity and mortality. Little is known about the indications and outcomes of pneumonectomy for pediatric tumors. The Pediatric Surgical Oncology Research Collaborative (PSORC) identified pediatric patients <21 years of age who underwent pneumonectomy from 1990 to 2017 for primary or metastatic tumors at 12 institutions. Clinical information was collected; outcomes included operative complications, long-term function, recurrence, and survival. Univariate log rank, and multivariable Cox analyses determined factors associated with survival. Thirty-eight patients (mean 12 ± 6 yrs) were identified; median (IQR) follow-up was 19 (5-38) months. Twenty-six patients (68%) underwent pneumonectomy for primary tumors and 12 (32%) for metastases. The most frequent histologies were osteosarcoma (n = 6), inflammatory myofibroblastic tumors (IMT; n = 6), and pleuropulmonary blastoma (n = 5). Median postoperative ventilator days were 0 (0-1), intensive care 2 (1-3), and hospital 8 (5-16). Early postoperative complications occurred in 10 patients including 1 death. Of 25 (66%) patients alive at 1 year, 15 reported return to preoperative pulmonary status. All IMT patients survived while all osteosarcoma patients died during follow-up. On multivariable analysis, metastatic indications were associated with nonsurvival (HR = 3.37, P = 0.045). This is the largest review of children who underwent pneumonectomy for cancer. There is decreased procedure-related morbidity and mortality than reported for adults. Survival is worse with preoperative metastatic disease, especially osteosarcoma.

Immediate results of pneumonectomy in the complex treatment of patients with destructive pulmonary tuberculosis

Introduction. Currently, surgical methods in the compre-hensive treatment of patients with pulmonary tuberculosis remain in demand all over the world. Among them, pneu-monectomy is performed in 10.3–21.8% of cases and is of-ten accompanied by various postoperative complications.Objective. Study of the immediate results of pneu-monectomy in the comprehensive treatment of patients with destructive pulmonary tuberculosis.Material and methods. A continuous retrospective study was carried out in 2012 through 2017. Inclusion criteria: pa-tients between 18 and 75 years; diagnosis verified by cul-ture technique; total destructive lesion of one of the lungs; chemotherapy for at least 6 months, taking into account the data on MTB drug sensitivity. Exclusion criteria: pre-sence of a destructive lesion in the contralateral lung. 129 patients were enrolled into the study. Patients’ sex, age, duration of the disease, complications of pulmonary tuber-culosis before surgery, MTB drug sensitivity, bacterial shed-ding, X-ray changes, respiratory function, lung perfusion, comorbidity and degree of activity of a specific process were studied, as well as the characteristics of surgical inter-ventions, intraoperative and postoperative complications. Postoperative complications were assessed in accordance with TM&amp;M classification. Differences between groups were determined using the χ2 test. A p value less than 0.05 was considered to be statistically significant.Results. Complications in the early postoperative period developed in 52 (40.4%) patients; 26 (20.2%) patients had minor complications, 26 (20.2%) major ones. In postope-rative period 1 (0.8%) patient died. Postoperative compli-cations were eliminated in 125 (96.9%) patients. Among bacillary patients, bacterial shredding ceased in 80 (91%). Satisfactory immediate result was achieved in 120 (93%) patients, unsatisfactory, in 9 (7%). In the group of patients with major postoperative complications there were sig-nificantly more patients with a disease duration of more than 36 months, as well as those with HCV infection and MDR/XDR MTB (p&lt;0.05).Conclusion. Pneumonectomy is a highly effective opera-tion in the comprehensive treatment of patients with uni-lateral destructive pulmonary tuberculosis

P2.18-15 Surgical Outcomes of Pneumonectomy After Induction Therapy for Non-Small-Cell Lung Cancer

P2.18-15 Surgical Outcomes of Pneumonectomy After Induction Therapy for Non-Small-Cell Lung Cancer

Short-and long-term outcomes of pneumonectomy for non-small cell lung cancer

Objective To assess the mortality, complications and major morbidity of pneumonectomy for non-small cell lung cancer(NSCLC) and to establish the importance of various prognostic factors. Methods The data of 64 consecutive patients who underwent pneumonectomy for NSCLC were retrospectively reviewed. Results The 30-day mortality rate was 7.8%(5/64). Complications developed in 29.7%(19/64) and overall 5-year survival was 19.0%.Pathological stage Ⅲ(P=0.030) and right pneumonectomy(P=0.010) were independent risk factors of an adverse outcome.Survival was not significantly influenced by histological types (P=0.125) or curability (P=0.587). Conclusion Pneumonectomy is associated with acceptable overall morbidity and mortality.However, the patients with pathological stage Ⅲ or right pneumonectomy require special consideration.Pneumonectomy should be performed only in selected patients. Key words: Pneumonectomy; Carcinoma, non-small-cell lung; Survival rate

Short- and long-term outcomes of pneumonectomy in a tertiary center.

Surgery is the most important therapeutic modality for lung cancer. Surgical outcomes are normally reported as 30-day or 90-day mortality or 5-year survival; 10-year survival is rarely mentioned in national data or international studies. Three hundred and six patients (79% male) underwent pneumonectomy, mainly for lung cancer, from January 1998 to February 2013. Their short- and long-term outcomes up to September 2014 were analyzed retrospectively. The mean age was 64 years (range 22-82 years) and 24% were aged ≥70 years. Thoracoscore was used to calculate the risk of hospital mortality. Operative mortality was 4.5% whereas predicted mortality was 8%. The operative mortality for cancer patients was 3.3%; the national mortality for lung cancer is 6.5%. Only 2 patients died in hospital after a pneumonectomy in the last 5 years. Half of the patients who died in hospital were ≥70 years old; 29% (4 patients) died after urgent operations for nonmalignant disease. Overall 5- and 10-year survival was 32% and 20%. Median and mean survival was 26 and 57 months, respectively. Long-term survival was better in females aged <70 years, in left pneumonectomy patients, and in those with squamous cell lung cancer. Our mortality for pneumonectomy was 50% less than the national mortality rate and significantly lower than that predicted by the Thoracoscore for lung cancer. This confirms that pneumonectomy is still an effective modality for the treatment of lung cancer, with low operative mortality and good long-term survival, especially in younger patients.

Evaluate the outcome of pneumonectomy for stage III a-N2 NSCLC

Results During the study, 184 patients underwent surgical resection of stage III a-N2 non-small cell lung cancer. Among them, 35 patients had pneumonectomy, 29 patients (83%) were male, and 6 (17%) were female. The median age was 57 years (43 yrs-77 yrs) old, and the median follow up duration was 77 month. 27 patients (77%) had induction chemotherapy before operation. Right pneumonectomy was performed in 13 patients (37%), and Left pneumonectomy was done in 22 patients (63%). The 5-year survival was 58% in pneumonectomy, 28% in the right pneumonectomy and 76% in the left pneumonectomy, respectively. Left pneumonectomy(p = 0.021) and complete resectability (p = 0.017) were positive prognostic factor, but the induction chemotherapy before operation was negative prognostic factor. (p = 0.040)

A comparison of the intensive care unit outcomes of pneumonectomy and lobectomy patients with lung cancer

A comparison of the intensive care unit outcomes of pneumonectomy and lobectomy patients with lung cancer

Pneumonectomy for node-positive non-small cell lung cancer: can it be a treatment option for N2 disease?

The feasibility of multimodality therapy in patients with node-positive non-small cell lung cancer (NSCLC) requiring pneumonectomy and the role of pneumonectomy in N2 disease remain controversial. This study evaluated outcomes in patients with node-positive NSCLC undergoing pneumonectomy in a community hospital. Perioperative and long-term outcomes of 37 patients with node-positive (pN1-2) NSCLC undergoing pneumonectomy from September 1994 to April 2010 as a clinical practice were retrospectively analyzed. Twenty patients received induction therapy, and 17 received preoperative chemoradiation (30-40 Gy). Fifteen patients and 22 patients underwent right and left pneumonectomy, respectively. A postoperative complication occurred in 8 patients. In-hospital mortality occurred in 1 patient. Induction therapy did not increase the operative risk including operative time, blood loss and postoperative complications. Nineteen patients were given a diagnosis of pN2. Although 7 bulky N2 patients and 10 multi-station N2 patients were included, 5-year overall survival was 34.3 % in pN1 and 28.0 % in pN2 (p = 0.998), respectively. Twenty-three patients received additional postoperative therapy. Five patients died within 3 months postoperatively due to distant metastases. Induction therapy and laterality did not influence survival. Extended resection, such as vagus nerve or chest wall resection, predicted an unfavorable outcome in multivariate analysis (Hazard ratio 2.81, p = 0.032). The safety and acceptable long-term outcome of pneumonectomy as a general clinical practice were shown for both pN1 and pN2 patients with various preoperative or postoperative therapies. Extended resection due to the extrapleural or extranodal involvement of tumor was an unfavorable prognostic factor.

Early and Long-term Outcomes of Pneumonectomy for Treating Sequelae of Pulmonary Tuberculosis

BackgroundPneumonectomy remains the ultimate curative treatment modality for destroyed lung caused by tuberculosis despite multiple risks involved in the procedure. We retrospectively evaluated patients who underwent pneumonectomy for treatment of sequelae of pulmonary tuberculosis to determine the risk factors of early and long-term outcomes.Materials and MethodsBetween January 1980 and December 2008, pneumonectomy or pleuropneumonectomy was performed in 73 consecutive patients with destroyed lung caused by tuberculosis. There were 48 patients with empyema (12 with bronchopleural fistula [BPF]), 11 with aspergilloma and 7 with multidrug resistant tuberculosis.ResultsThere were 5 operative mortalities (6.8%). One patient had intraoperative uncontrolled arrhythmia, one had a postoperative cardiac arrest, and three had postoperative respiratory failure. A total of 29 patients (39.7%) suffered from postoperative complications. Twelve patients (16.7%) were found to have postpneumonectomy empyema (PPE), 4 patients had wound infections (5.6%), and 7 patients required re-exploration due to postoperative bleeding (9.7%). The prevalence of PPE increased in patients with preoperative empyema (p=0.019). There were five patients with postoperative BPF, four of which occurred in right-side operation. The only risk factor for BPF was the right-side operation (p=0.023). The 5- and 10-year survival rates were 88.9% and 76.2%, respectively. The risk factors for late deaths were old age (≥50 years, p=0.02) and low predicted postoperative forced expiratory volume in one second (FEV1) (<1.2 L, p=0.02).ConclusionAlthough PPE increases in patients with preoperative empyema and postoperative BPF increases in right-side operation, the mortality rates and long-term survival rates were found to be satisfactory. However, the follow-up care for patients with low predicted postoperative FEV1 should continue for prevention and early detection of pulmonary complication related to impaired pulmonary function.

Quality of life in patients with stage III non-small-cell lung cancer during multimodality treatment

Quality of life (QL) was studied in 185 patients with stage III non-small cell lung cancer at the stages of multimodality treatment involving neoadjuvant chemotherapy with paclitaxel/carboplatin, radical surgery, and intraoperative radiotherapy (the single dose was 10 and 15 Gy) in the presence of gemzar or cisplatin radiosensitization. The EORTC QLQ-30 (version 3.0) and EORTC QLQ-LC13 questionnaires were used to estimate QL. The latter was shown to be determined by the performed courses of chemotherapy and the volume of surgical intervention. Neoadjuvant chemotherapy increases physical functioning (92.3±2.3%) and total health status (71.1±3.9%) versus the pretreatment values (81.4±3.3 and 61.8±4.1%, respectively). After surgical treatment, the functional parameters of QL depend on the volume of surgery: the results of pneumonectomy were worse (56.3±5.7) than those of lung resection (66.5±4.5%). Intraoperative radiotherapy in a single dose of 10 and 15 Gy, gemzar or cisplatin radiosensitization exerted no impact on QL indicators. The final stage of rehabilitation after multimodality treatment is performed at a 12-24-month interval.

La pneumonectomie pour les formes actives et séquellaires de la tuberculose

Lung resection retains an important place in the treatment of certain forms of tuberculosis. The purpose of this review was to review the indications for and outcomes of pneumonectomy both in the management of active TB and the treatment of its consequences. Between 2003 and 2007 85 patients underwent a pneumonectomy for TB; 48 men and 37 women with a mean (sd) age of 36.7 (10.9) years. Chronic sputum production and haemoptysis were the main presenting features. The indication for surgery was a single destroyed lung in 34 cases, an aspergilloma in 29 cases, tuberculous empyema in 14 and multidrug resistant TB in 5. The procedure undertaken was a pneumonectomy in 32 cases a pleurectomy and pneumonectomy in 45 cases and a completion pneumonectomy in 8 cases. There were 4 deaths (4.7%) and in 13 cases (15.3%) a pyothorax developed in the pneumonectomy cavity. In 4 cases a broncho-pleural fistula occurred. Long term results were satisfactory with a median follow up of 2.8years (range 3 months to 5 years). Male sex (p=0.02), right sided pneumonectomy (p=0.01) diabetes (p=0.001), a low level of haemoglobin (p=0.03) or serum protein (p<0.001) were associated with an increased risk of pneumonectomy cavity infection. Right sided surgery (p=0.01), post operative transfusion (p=0.01) and pre-operative empyema (p=0.05) were all associated with risk of bronchial dehiscence. Optimising preoperative condition and identification of patients at risk of complications are essential for reducing the burden of post-operative complications.

Persistent N2 Disease After Induction Therapy Does Not Jeopardize Early and Medium Term Outcomes of Pneumonectomy

Operative management of patients with persistent N2 disease after induction therapy is still debated. One hundred fifty-three consecutive patients underwent pneumonectomy from January 1999 until July 2005; 28 patients (18.3%) had persistent N2 disease after induction therapy (group 1), 32 patients (20.9%) had pathologic stage N0 or N1 after induction therapy (group 2), and 93 patients (60.8%) with pathologic N2 disease underwent immediate surgery (group 3). Short-term end points were operative mortality at 30 and 90 days and major complications. Long-term end points were 5-year survival and disease-free survival rates. Demographics of the three groups were similar (age, sex, side of operation, type of chemotherapy, smoking status, and comorbidity such as coronary artery disease, diabetes, and chronic obstructive pulmonary disease). Thirty-day postoperative mortality was 10.7% in group 1, 3.1% in group 2 (p = 0.257), and 4.3% in group 3 (p = 0.201); 90-day postoperative mortality was 10.7% in group 1, 12.5% in group 2 (p = 0.577), and 9.7% in group 3 (p = 0.558). Incidence of major postoperative complications was similar. Five-year survival rate was 32.2% (median, 28 months; 95% confidence interval, 7 to 43) in group 1, 34.8% (median, 27 months; 95% confidence interval, 7 to 47) in group 2 (p = 0.685), and 12.4% (median, 15 months; 95% confidence interval, 11 to 19) in group 3 (p = 0.127). No statistical difference was found in terms of 5-year event-free survival, or regarding the side of pneumonectomy. Our results suggest that pneumonectomy is justified in patients with persistent N2 disease after induction chemotherapy.