Pneumonectomy for lung cancer: Contemporary national early morbidity and mortality outcomes

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 149; no. 1; pp. 73 - 83
• Main Authors: Thomas, Pascal A., MD, FECTS, Berbis, Julie, MD, Baste, Jean-Marc, MD, Le Pimpec-Barthes, Françoise, MD, Tronc, François, MD, Falcoz, Pierre-Emmanuel, MD, Dahan, Marcel, MD, Loundou, Anderson, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2015
• Subjects: Aged; Cardiothoracic Surgery; Comorbidity; Databases, Factual; Elective Surgical Procedures; Female; France - epidemiology; Hospital Mortality; Humans; Logistic Models; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision; Male; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Obesity - mortality; Odds Ratio; Pneumonectomy - adverse effects; Pneumonectomy - mortality; Postoperative Complications - mortality; Propensity Score; Protective Factors; Risk Factors; Time Factors; Treatment Outcome; France; OR; World Health Organization; body mass index; CI; American Society of Anesthesiologists; odds ratio; chronic obstructive pulmonary disorder; ASA; 10.4; Medical Research Council; acute respiratory distress syndrome; confidence interval; FEV1; forced expiratory volume in 1 second; ARDS; 10; BMI; COPD; MRC; WHO
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.09.063

Objective The study objective was to determine contemporary early outcomes associated with pneumonectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database (EPITHOR). Methods After discarding inconsistent files, a group of 4498 patients who underwent elective pneumonectomy for primary lung cancer between 2003 and 2013 was selected. Logistic regression analysis was performed on variables for mortality and major adverse events. Then, a propensity score analysis was adjusted for imbalances in baseline characteristics between patients with or without neoadjuvant treatment. Results Operative mortality was 7.8%. Surgical, cardiovascular, pulmonary, and infectious complications rates were 14.9%, 14.1%, 11.5%, and 2.7%, respectively. None of these complications were predicted by the performance of a neoadjuvant therapy. Operative mortality analysis, adjusted for the propensity scores, identified age greater than 65 years (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5-2.9; P  < .001), underweight body mass index category (OR, 2.2; 95% CI, 1.2-4.0; P  = .009), American Society of Anesthesiologists score of 3 or greater (OR, 2.310; 95% CI, 1.615-3.304; P  < .001), right laterality of the procedure (OR, 1.8; 95% CI, 1.1-2.4; P  = .011), performance of an extended pneumonectomy (OR, 1.5; 95% CI, 1.1-2.1; P  = .018), and absence of systematic lymphadenectomy (OR, 2.9; 95% CI, 1.1-7.8; P  = .027) as risk predictors. Induction therapy (OR, 0.63; 95% CI, 0.5-0.9; P  = .005) and overweight body mass index category (OR, 0.60; 95% CI, 0.4-0.9; P  = .033) were protective factors. Conclusions Several risk factors for major adverse early outcomes after pneumonectomy for cancer were identified. Overweight patients and those who received induction therapy had paradoxically lower adjusted risks of mortality.