title: Extended pneumonectomy for non-small cell lung cancer: morbidity, mortality, and long-term results.
abstract: OBJECTIVE
  Pneumonectomy is not always sufficient for the radical resection of cancer. In the present study, pneumonectomy may be associated with an extended resection of mediastinal or parietal structures. The postoperative risk and the oncologic benefits of such an extended procedure have not been sufficiently demonstrated.
  
  
  METHODS
  We have defined "extended" pneumonectomy (EP) as the removal of the entire lung, associated with one or more of the following structures: superior vena cava, tracheal carina, left atrium, aorta, chest wall, or diaphragm. Our clinical database was retrospectively reviewed to identify patients who underwent EP to assess their postoperative morbidity, mortality, and long-term survival.
  
  
  RESULTS
  Between 1998 and 2005, 47 EPs were performed. The "extended" procedure included left atrium resection in 15 patients, combined SVC and carinal resection in 9 patients, aortic resection in 8 patients (in 3 patients with prosthetic replacement), chest wall or diaphragmatic resection in 6 patients, SVC resection in 4 patients, and carinal resection in 4 patients. A partial esophageal muscular resection was performed in 1 patient. Overall 60-day mortality was 8.5%. Major postoperative complications occurred in 8 patients (17%). The 2- and 5-year survival rates for the overall population were 42% and 22.8%, respectively. Interestingly, long-term survivors were recorded only in the group of patients who received induction treatment.
  
  
  CONCLUSIONS
  Extended pneumonectomy is a feasible procedure with an acceptable risk factor. To improve the selection of patients, all candidates should undergo preoperative mediastinoscopy and induction chemotherapy. In patients with positive response to chemotherapy or stable disease, extended pneumonectomy may afford a radical resection in more than 80% of cases and may result in a permanent cure in some instances.
authors.affiliation: Thoracic Surgery Department, European Institute of Oncology, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Borri
authors.forename: Francesco
authors.initials: F
authors.lastname: Leo
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Solli
authors.forename: Domenico
authors.initials: D
authors.lastname: Galetta
authors.forename: Roberto
authors.initials: R
authors.lastname: Gasparri
authors.forename: Francesco
authors.initials: F
authors.lastname: Petrella
authors.forename: Paolo
authors.initials: P
authors.lastname: Scanagatta
authors.forename: Davide
authors.initials: D
authors.lastname: Radice
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D011013:Pneumonectomy / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D016896:Treatment Outcome