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Lung Cancer |

Pneumonectomy in Lung Cancer: Analysis of Predictive Factors of Postoperative Morbidity and Mortality

Ileana Palma*, MD; Silvia Quadrelli, MD; Gustavo Lyons, MD; Leonardo Pankl, MD; Matías Lescano, MD; Eugenia Dipietro, MD; Domingo Chimondeguy, MD
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British Hospital of Buenos Aires, Buenos Aires, Argentina


Chest. 2012;142(4_MeetingAbstracts):621A. doi:10.1378/chest.1389384
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Abstract

SESSION TYPE: Lung Cancer III

PRESENTED ON: Tuesday, October 23, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Objective: To analyse predictive factors of postoperative complications and mortality after pneumonectomy.

METHODS: Retrospectively collected data was analysed, at a single center, on 570 patients undergoing lung resection for NSCLC with curative intent between January 1986 and March 2011.

RESULTS: There were 66 pneumonectomies. Most were men (74.2%) and under 70 years old (97%). Smokers were 89.4%. The prevalence of previous malignancy was 4.7%, the frequency of presentation as SPN was 16.9%, right upper lobe location in 26.6%, 29.7% lower and 54.7% in middle lobe, and with involvement of bronchus 7.9%. The clinical stages were IA 16.7%, IB 43.9%, and IIB 39.4%. During surgery, the prevalence of tumors larger than 3 cm was 85.7%, N2 disease 34.4%, pleural invasion 15.6% and regional involvement 51.6%. The prevalence of adenocarcinoma was 47%. Pneumonectomy was considered curative in 71.9% with a postoperative complication rate of 43.1% and 20.6% operative mortality. In 50.8% of patients, the pneumonectomy was performed on the right side, with an operative mortality of 24.2% (vs. 16.7% on the left side, p = 0.542). The median survival of stage I patients was not different compared to other surgical procedure (51.03 vs. 142.27, Kaplan-Meier log rank p = 0.912). We performed a multivariate analysis of postoperative morbidity and mortality: complete resection (OR 0.18, 95% CI 0.04 to 0.75, p = 0.019) and curative resection (OR 0.15, 95% CI 0.04 to 0.58, p = 0.005) were protective factors; and age over 70 years old (OR 7.5, 95% CI 1.09 - 51.51, p = 0.04) and the presence of postoperative complications (OR 11.68, 95% CI 2.31 - 59.03, p = 0.002) were predictors of mortality.

CONCLUSIONS: Pneumonectomy has high postoperative morbidity and mortality. The age over 70 and the presence of postoperative complications were predictor factors of mortality. In our center, we found no significant difference in median survival, nor operative mortality in right pneumonectomy.

CLINICAL IMPLICATIONS: The surgical discussion on pneumonectomy has focused on the high postoperative morbidity and mortality rate and its possible impact on long-term survival.

DISCLOSURE: The following authors have nothing to disclose: Ileana Palma, Silvia Quadrelli, Gustavo Lyons, Leonardo Pankl, Matías Lescano, Eugenia Dipietro, Domingo Chimondeguy

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British Hospital of Buenos Aires, Buenos Aires, Argentina

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