title: Impact of laterality on early and late survival after pneumonectomy.
abstract: BACKGROUND
  This study evaluated the effect of laterality on survival in patients who underwent pneumonectomy for lung cancer.
  
  
  METHODS
  We reviewed the Surveillance, Epidemiology, and End Results (SEER) database for patients who underwent pneumonectomy for lung cancer from 1988 through 2006. Predictors of survival were determined by univariate and multivariable analysis.
  
  
  RESULTS
  A total of 9746 patients had pneumonectomies. Left pneumonectomies (56%) were more common than right; 67% of patients were men with mean age of 63 years (range, 12 to 92 years). Tumor pathology was squamous cell in 49% and adenocarcinoma in 34%. Stage distribution was stage I, 28%; stage II, 28%; stage IIIA, 19%; stage IIIB, 18%; and stage IV, 6%. Overall survival was 67% and 40%, respectively, at 1 and 3 years; with 63% and 39% for right vs 70% and 41% for left (p<0.001). Mortality at 1 and 3 months was 8% and 16% for right pneumonectomies and 4% and 9% for left (p<0.001). Multivariate predictors of worse survival were right pneumonectomy, age, stage, male sex, tumor size, grade, prior malignancy, not married, number of positive lymph nodes, and fewer lymph nodes evaluated (all p<0.05). The adjusted hazard ratio for right pneumonectomy was 1.12 (95% confidence interval, 1.07 to 1.18; p<0.00001). For 3-month survival, right pneumonectomy had an adjusted odds ratio of 2.01 (95% confidence interval, 1.77 to 2.29; p<0.001). Neoadjuvant radiotherapy did not affect 3-month survival (adjusted odds ratio, 0.88; 95% confidence interval, 0.1 to 7.03, p=0.9).
  
  
  CONCLUSIONS
  A right pneumonectomy is associated with approximately twice the perioperative mortality as a left pneumonectomy. However, neoadjuvant radiotherapy does not appear to add incremental risk, and long-term survival is not affected by laterality.
authors: Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, Georgia 30322, USA. felix.fernandez@emoryhealthcare.org
authors: Felix G
authors: FG
authors: Fernandez
authors: Seth D
authors: SD
authors: Force
authors: Allan
authors: A
authors: Pickens
authors: Patrick D
authors: PD
authors: Kilgo
authors: Theresa
authors: T
authors: Luu
authors: Daniel L
authors: DL
authors: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D016019:Survival Analysis; D013997:Time Factors