Pneumonectomy for bronchogenic carcinoma: analysis of factors predicting short- and long-term outcome.
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.
Veen
Eelco J
EJ
Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands. eveen@amphia.nl
Janssen-Heijnen
Maryska L G
ML
Ritchie
Ewan D
ED
Biesma
Bonne
B
van den Bogart
Marco P H
MP
Bolhuis
Robert Jan
RJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome