Nutritional status and postoperative outcome after pneumonectomy for lung cancer

BACKGROUND

The influence of nutritional status on outcome after major lung resection remains controversial. Nutritional assessment is not included as a major recommendation in lung cancer guidelines. The purpose of this study was to assess the nutritional status of patients referred for pneumonectomy and to assess the predictive value of malnutrition in determining the surgical outcome.

METHODS

This study was a multicenter observational trial. The eligibility criterion for participants was pneumonectomy for lung cancer. Criteria for group classification according to nutritional status were albumin and transthyretin levels. Predicted outcomes were major infectious and noninfectious complications and 90-day mortality. Univariate analysis identified independent variables for the predictive model of age, sex, induction chemotherapy, extended resections, treatment side, smoking, and malnutrition. Predictive variables were then included in a logistic regression model.

RESULTS

Between January 2010 and December 2011, 86 (mean age, 61.5 years) consecutive patients referred for pneumonectomy (left side, n = 58; right side, n = 28) at 4 thoracic surgery centers were included. The malnutrition group included 33 patients (39%) and the normal nutritional status group included 53 patients. Univariate analysis elected malnutrition, recent active smoking, and extended resection to be included in a multivariate analysis. Multivariate analysis identified malnutrition, recent smoking, and extended resection as predictive variables for major complications and mortality.

CONCLUSIONS

The frequency of malnutrition detected by biological markers was dramatically high. Malnutrition, as well as recent active smoking and extended resection, is a predictive factor for infectious complications and mortality after pneumonectomy. Nutritional assessment with appropriate markers should be considered before pneumonectomy.

Sleeve Lobectomy Versus Pneumonectomy: Tumor Characteristics and Comparative Analysis of Feasibility and Results

BACKGROUND

Sleeve lobectomy (SL) seems to have better results than pneumonectomy. Some authors propose to extend its indications. The aim of this study was to compare postoperative results, locoregional recurrence, and survival after sleeve lobectomy and pneumonectomy in focusing on right upper lobe cancer.

METHODS

From 1984 to 2002, 973 lung resections were performed for T1, T2, and bronchial T3 right upper lobe non-small cell lung cancer. There were 756 lobectomies (L group), 151 pneumonectomies (RP group), and 66 sleeve lobectomies (SL group). The RP group was further divided with regard to intrapulmonary lymph node involvement. Pneumonectomy 1 (RP1) was a group of N0, intralobar N1, and skip metastasis involvement (N0-N2). Pneumonectomy 2 (RP2) was a group of extralobar N1 and nonskip metastasis involvement (N1-N2). Postoperative results were compared among SL, L, and RP groups. Survival was compared between the two homogeneous groups for oncologic characteristics (SL, RP1).

RESULTS

Statistical comparison of 5-year actuarial survival showed a significant difference favoring SL (SL: 72.5%/ RP1: 53.2%; p = 0.0025). Postoperative mortality was higher after RP (L: 2.9% / SL: 4.5%/ RP: 12.6 %). Significant factors limiting SL were tumor size, extralobar N1, and main bronchus involvement (p = 0.000026, 0.0002, and 0.005, respectively).

CONCLUSIONS

Immediate and long-term survival appears better after sleeve lobectomy than right pneumonectomy for comparable stages of right upper lobe cancer. For frequency to increase by systematic attempt at SL, limited by large tumors and extralobar N1 involvement, the only way should be after favorable response to induction chemotherapy.