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Pneumonectomy for bronchogenic carcinoma: analysis of factors predicting short- and long-term outcome

^a Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
^b Department of Research, Eindhoven Cancer Registry, Eindhoven, The Netherlands
^c Department of Pulmonology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
^d Department of Pulmonology, Bernhoven Hospital, Oss, The Netherlands

*Corresponding author. Amphia Hospital, location Molengracht, 4818 CK, Breda, The Netherlands. Tel.: +31-76-5951151; fax: +31-76-5953818.

E-mail address: eveen{at}amphia.nl (E.J. Veen).

The objective of this study was to analyse predictive factors for postoperative and long-term outcome after pneumonectomy. From 1 January 2000 to 1 January 2005 a total of 91 (31%) pneumonectomies were performed. Multivariable analysis for postoperative morbidity, mortality, and long-term survival was performed. Patients over 70 years had 1.5 times higher risk of dying (HR=1.5, 95% CI=1.1–2.0) within five years compared to younger patients, those with co-morbidity had 1.8 times higher risk compared to no co-morbidity (HR=1.8, 95% CI=1.3–2.7) and those with stage IIIA had 2.3 times higher risk of dying compared to stage I (HR=2.3, 95% CI=1.5–3.6). Overall postoperative mortality within 30 days in patients undergoing pneumonectomy was 10% (n=9). Most patients who died postoperatively were 70 years or older, had cardiovascular comorbidity and underwent right-sided pneumonectomy (n=6). Patients over 70 years had three times higher risk of complications compared to younger patients (OR=3.1, 95% CI=1.1–8.2), and patients undergoing right-sided pneumonectomy had 2.4 times higher risk compared to left-sided pneumonectomy (OR=2.4, 95% CI=0.9–6.4). Pneumonectomy is accompanied by high postoperative mortality and morbidity rates, the highest risk in patients over 70 years and right-sided pneumonectomy, and consequently should lead to meticulous patient selection and perioperative care.

Key Words: Pneumonectomy; Outcome measurement; Non-small cell lung cancer