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

The analysis of prognosis factor in patients with non-small cell lung cancer receiving pneumonectomy

Background

Pneumonectomy is a procedure that possesses several side effects, but is sometimes necessary in the management of non-small cell lung cancer (NSCLC). The benefits of pneumonectomy have yet to be clearly outlined.

Methods

Data of 100 cases were extracted from the medical records of patients that underwent a pneumonectomy for NSCLC from January 2007 to December 2016. Primary outcomes were 5-year overall survival (OS) and 30-day mortality. Statistical comparisons were performed using the Chi-Square test. Kaplan-Meier curves were utilized to evaluate the 5-year OS which were compared using the log-rank test. Multivariable analysis of survival data was done using risk proportional model.

Results

The 5-year OS of NSCLC after pneumonectomy is 32.3%. Squamous cell carcinomas had a better prognosis than adenocarcinomas (P=0.039). Patients with higher N stage had a worse prognosis. Among patients undergoing pneumonectomy with N2 lymphatic metastasis, those who also underwent neoadjuvant therapy achieved a better 5-year OS (P=0.042). The 30-day mortality was 4.0%.

Conclusions

Pneumonectomy sometimes is inevitable and necessary in certain subtypes of NSCLC with acceptable perioperative mortality and long-term survival. For patients with NSCLC undergoing pneumonectomy, pathological diagnosis and nodal stage were independent predictors of OS. When pneumonectomy was done in patients with NSCLC and N2 lymphatic metastasis, a better long-term OS could be achieved amongst patients receiving neoadjuvant therapy compared to those without neoadjuvant therapy.

Pneumonectomy for Non-Small Cell Lung Cancer

Lung cancer is the leading cause of cancer deaths and its incidence continues to increase. Emerging therapies as part of a multimodal approach are making more patients eligible for surgical resection. As more surgeons are treating locally advanced non-small cell lung cancer they find themselves recommending pneumonectomy as the surgical component of the multidisciplinary plan. Performing a pneumonectomy is technically demanding and is associated with many potential perioperative comorbidities. With the proper preparation, experience, and attention to perioperative care, pneumonectomy can be carried out safely with excellent outcomes and a good quality of life.

Which is the Role of Pneumonectomy in the Era of Parenchymal-Sparing Procedures? Early/Long-Term Survival and Functional Results of a Single-Center Experience

AIM

Despite the increasing adoption of parenchymal-sparing procedures, pneumonectomy is still necessary in several pleural and pulmonary (benign or malignant) diseases. We reviewed clinical data of a large cohort of patients treated by pneumonectomy with the aim of better define its impact on early and long-term results.

METHODS

Clinical and pathological characteristics of all consecutive patients treated by pneumonectomy between January 2005 and May 2012 were retrospectively reviewed. Thirty- and 90-day mortality, as well as long-term survival was assessed. Factors associated to long-term survival were analyzed by univariate and multivariate analyses. Evaluation of quality of life was carried out by a standard questionnaire (SF-12) administrated by phone to patients surviving beyond 1 year.

RESULTS

A total of 398 patients (293 men; mean age 61 ± 10.9 years) were operated on in the study period. Indication was malignancy in 380 patients (350 primary lung cancers). Thirty-day mortality was 9 % (right: 12.6 % vs. left: 6.3 %, p = 0.013), significantly correlating with age (p = 0.021), comorbidities (p = 0.034), PS > 1 (p = 0.018), preoperative dyspnea (p = 0.0013), and FEV1 (p = 0.0071). Overall 1-, 3-, 5-, and 7-year survival rates were 76.6, 46.6, 34.4, and 29.2 %. In case of primary lung cancer, these figures were 76.8, 46.4, 34.5, and 29.7 %. At univariate analysis, a less favorable survival was associated to PS > 1 (p = 0.0078), right side (p = 0.044), occurrence of postoperative complications (p = 0.00079), and T3-4 status (p = 0.013). At multivariate analysis, PS > 1, right side, and occurrence of postoperative complications were identified as independent worse prognostic factors. SF12 physical score was 39.1 ± 9.0 and was correlated to the presence of preoperative symptoms (p = 0.013). Mental score was 50.68 ± 9.63 and was correlated to preoperative FEV1/FVC ratio (p = 0.023) and side of disease (p = 0.023).

CONCLUSION

In current practice, pneumonectomy is still performed for malignancy, sometimes after induction treatment. High postoperative morbidity and mortality are observed; however, at a farer interval time point, long-term survival with preserved quality of life can be observed.

Analysis of Pneumonectomy for Benign Disease: A Single Institution Retrospective Study on 59 Patients

INTRODUCTION

Pneumonectomy is the only curative treatment for some benign diseases but the operation is a challenging procedure. Herein, we present our experiences of pneumonectomy for 59 patients.

METHODS

The medical records of 59 patients who undergone pneumonectomy for benign lung diseases from 2008 to 2013 at the Division of Thoracic Surgery in Beijing Chest Hospital were retrospectively reviewed.

RESULTS

There were 23 male and 36 female patients. Three procedures including pneumonectomy, pleuropneumonectomy and completion pneumonectomy were used. The operative time and intraoperative blood loss were statistically different in the patients who undergone different operations. The operative time of the patients with and without tuberculosis had no difference but the intraoperative blood loss was more in the patients with tuberculosis (P = 0.035). The operative type, age and operative blood loss were relevant with the morbidity, the P value were 0.024, 0.042 and 0.027 respectively.

CONCLUSIONS

Pneumonectomy for patients with benign disease may be more difficult than for patients with lung cancer, mean while pleuropneumonectomy and completion pneumonectomy may be greater challenges. But with careful patient selection and operative technique, it is a satisfactory treatment method for benign lung disease. The morbidity is acceptable and associated with operative type, age and operative blood loss.