Long-term impact of complications after lung resections in non-small cell lung cancer

• Published in: Journal of thoracic disease Vol. 11; no. 5; pp. 2024 - 2033
• Main Authors: Shinohara, Shuichi, Kobayashi, Kenichi, Kasahara, Chinatsu, Onitsuka, Takamitsu, Matsuo, Masaki, Nakagawa, Makoto, Sugaya, Masakazu
• Format: Journal Article
• Language: English
• Published: China AME Publishing Company 01.05.2019
• Subjects: Original; long-term effect; complication; prognosis; Non-small cell lung cancer (NSCLC); surgery
• ISSN: 2072-1439; 2077-6624
• DOI: 10.21037/jtd.2019.04.91

Postoperative complications after lung resection are common and fatal. The immediate effects of postoperative complications are related to poor prognosis; however, the long-term effects have not been assessed. Thus, this investigation aimed to clarify the long-term effects of postoperative complications among patients with resected non-small cell lung cancer (NSCLC). This retrospective cohort study included 345 patients with resected NSCLC from a single institution. We used the Clavien-Dindo classification to classify postoperative complications. Postoperative complications were defined as complications with a Clavien-Dindo grade of ≥2. The Kaplan-Meier method was used to evaluate survival. Prognostic factors were analyzed using a Cox proportional hazard model. There were 110 patients with postoperative complications (31.9%). The 5-year overall survival (OS), recurrence-free survival (RFS), and cause-specific survival (CSS) rates were significantly lower in patients with complications than in those without complications [OS: 66.1%, 95% confidence interval (CI): 55.4-74.8% 78.0%, 95% CI: 71.8-83.1%, P=0.001; RFS: 48.8%, 95% CI: 38.1-58.7% 70.8%, 95% CI: 64.2-76.4%, P<0.001; CSS: 82.7%, 95% CI: 72.8-89.3% 88.2%, 95% CI: 82.8-92.0%, P=0.005]. The 5-year OS was lower in the pulmonary complication group than in the other complication group (58.1%, 95% CI: 40.0-72.4% 70.5%, 95% CI: 56.6-80.6%, P=0.033). Postoperative complications were indicated as a poor prognostic factor for OS (hazard ratio, 1.67; 95% CI: 1.11-2.53; P=0.002). Postoperative complications were associated with unfavorable OS because of the worse prognosis of postoperative pulmonary complications.