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J Thorac Cardiovasc Surg 2005;130:416-425
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

One hundred consecutive pneumonectomies after induction therapy for non-small cell lung cancer: An uncertain balance between risks and benefits

^a Department of Thoracic Surgery, Université de la Méditerranée (Aix-Marseille II), Faculty of Medicine, Sainte-Marguerite Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
^b Department of Oncology, Université de la Méditerranée (Aix-Marseille II), Faculty of Medicine, Sainte-Marguerite Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
^c Department of Medical Information & Biostatistics, Université de la Méditerranée (Aix-Marseille II), Faculty of Medicine, Sainte-Marguerite Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
^d UPRES EA 2201, IFR Jean Roche, Marseille, France.

Received for publication September 3, 2004; revisions received October 27, 2004; accepted for publication November 23, 2004.

^_* Address for reprints: Christophe Doddoli, MD, Service de Chirurgie Thoracique, Hôpital Sainte-Marguerite, 270, Bd de Sainte-Marguerite, 13274 Marseille Cedex 09, France. (Email: christophe.doddoli{at}mail.ap-hm.fr).

OBJECTIVE: We sought to assess postoperative outcome after pneumonectomy after neoadjuvant therapy in patients with non-small cell lung cancer.

METHODS: This retrospective study included 100 patients treated from January 1989 through December 2003 for a primary lung cancer in whom pneumonectomy had been performed after an induction treatment. Surgical intervention had not been considered initially for the following reasons: N2 disease (stage IIIA, n = 79), doubtful resectability (stage IIIB [T4, N0], n = 19), and M1 disease (stage IV [T2, N0, M1, solitary brain metastasis], n = 2). All patients received a 2-drug platinum-based regimen with a median of 2.5 cycles (range, 2–4 cycles), and 30 had associated radiotherapy (30–45 Gy).

RESULTS: There were 55 right and 45 left resections. Overall 30-day and 90-day mortality rates were 12% and 21%, respectively. At multivariate analysis, one inde- pendent prognostic factor entered the model to predict 30-day mortality: postoperative cardiovascular event (relative risk, 45.7; 95% confidence interval, 3.7–226.7; P = .001). Four variables predicted 90-day mortality: age of more than 60 years (relative risk, 5.06; 95% confidence interval, 1.47–17.48; P = .01), male sex (relative risk, 8.25; 95% confidence interval, 1.01–67.34; P = .049), postoperative respiratory event (relative risk, 3.64; 95% confidence interval, 1.14–9.37; P = .007), and postoperative cardiovascular event (relative risk, 7.84; 95% confidence interval, 3.12–19.71; P < .001). Estimated overall survivals in 90-day survivors were 35% (range, 29%-41%) and 25% (range, 19.3%-30.7%) at 3 and 5 years, respectively. At multivariate analysis, one independent prognostic factor entered the model: pathologic stage III-IV residual disease (relative risk, 1.89; 95% confidence interval, 1.09–3.26; P = .022).

CONCLUSIONS: Pneumonectomy after induction therapy is a high-risk procedure, the survival benefit of which appears uncertain.

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