Pneumonectomy after chemoradiation therapy for non-small cell lung cancer: does "side" really matter?
BACKGROUND
The long-term benefits and risks of pneumonectomy after neoadjuvant chemoradiation therapy remain controversial. This study evaluated our experience with pneumonectomy for advanced non-small cell lung cancer (NSCLC) after concurrent chemoradiation therapy.


METHODS
We reviewed medical records from patients undergoing concurrent chemoradiation therapy, followed by pneumonectomy (1983 to 2007). Clinical variables affecting Kaplan-Meier survival were analyzed.


RESULTS
After chemoradiation therapy, 129 pneumonectomies (right, 65; left, 64) were performed. Postoperative pathologic stages were complete responders (CR), 21; I, 23; II, 19; III, 62; and IV, 4. The 90-day perioperative mortality was 20% (13 of 65) after right-sided pneumonectomy vs 9% (6 of 64) after left-sided pneumonectomy (p = 0.084). Complications occurred in 33% (43 of 129), including bronchopleural fistula in 12% (16 of 129) and acute respiratory distress syndrome in 2% (3 of 129). Overall 5-year survival was 33%. Survival was 32% for right-sided sections vs 34% for left-sided. CR patients had a 5-year survival of 48%. Survival of patients with postoperative N0, N1, and N2 nodes was 42%, 26%, and 28%, respectively. Multivariate analysis showed the development of major complications negatively affected 5-year survival for patients undergoing right-sided pneumonectomy (hazard ratio, 0.462; p = 0.0399).


CONCLUSIONS
Pneumonectomy after concurrent chemoradiation therapy achieved long-term survival. When neoadjuvant therapy resulted in complete response or nodal downstaging, survival was improved. The risk of early perioperative death and complications was higher for right-sided procedures, but long-term survival did not differ between right- and left-sided pneumonectomy. Major complications negatively affected 5-year survival with right-sided pneumonectomies.
Kim
Anthony W
AW
Division of Thoracic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Faber
L Penfield
LP
Warren
William H
WH
Basu
Sanjib
S
Wightman
Sean C
SC
Weber
James A
JA
Bonomi
Philip
P
Liptay
Michael J
MJ
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment