title: An analysis, systematic review, and meta-analysis of the perioperative mortality after neoadjuvant therapy and pneumonectomy for non-small cell lung cancer.
abstract: OBJECTIVE
  Pneumonectomy after neoadjuvant therapy remains controversial.
  
  
  METHODS
  A systematic PubMed search was performed for original articles from 1990 through 2010 describing pneumonectomy after neoadjuvant therapy. Specific data on 30-day and 90-day perioperative mortalities were abstracted from these articles. Meta-analysis compared 30-day mortality between right and left pneumonectomy with a fixed-effects model. Comparison between 30-day and 90-day mortalities was also performed.
  
  
  RESULTS
  The search strategy yielded 27 studies. Overall, 30-day and 90-day perioperative mortalities were 7% and 12%, respectively. Among 15 studies providing side-specific 30-day mortality, cumulative mortalities were 11% and 5% for right and left pneumonectomies, respectively. In the meta-analysis that included 10 studies, 30-day mortality for right pneumonectomy remained greater than for left pneumonectomy (odds ratio, 1.97; 95% confidence interval, 1.11-3.49; P = .02). Among 6 studies providing side-specific 90-day mortality, cumulative mortalities were 20% and 9% for right and left pneumonectomies, respectively. In the meta-analysis that included 4 studies, 90-day mortality for right pneumonectomy was greater than for left pneumonectomy (odds ratio, 2.01; 95% confidence interval, 1.09-3.72; P = .03). Among 11 studies providing both 30-day and 90-day mortalities, mortality difference was 5% (95% confidence interval, 4%-7%, P < .0001). Pulmonary complications were the most common cause of 30-day and 90-day deaths.
  
  
  CONCLUSIONS
  Right pneumonectomy is associated with significantly higher 30-day and 90-day mortalities after neoadjuvant therapy than left pneumonectomy. Also, 90-day mortality for all pneumonectomies appears to be greater than expected, suggesting that the 30-day mortality figure may inadequately assess the perioperative mortality.
authors: Section of Thoracic Surgery, School of Medicine, Yale University, New Haven, Conn 06520, USA. anthony.kim@yale.edu
authors: Anthony W
authors: AW
authors: Kim
authors: Daniel J
authors: DJ
authors: Boffa
authors: Zuoheng
authors: Z
authors: Wang
authors: Frank C
authors: FC
authors: Detterbeck
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery*; D020360:Neoadjuvant Therapy; D011013:Pneumonectomy / Q000401:mortality*; D013997:Time Factors