title: Completion pneumonectomy in patients with cancer: postoperative survival and mortality factors.
abstract: OBJECTIVE
  To describe postoperative complications and long-term outcomes of completion pneumonectomy and highlight prognostic factors.
  
  
  METHODS
  We retrospectively reviewed the records of 46 patients (38 men, 8 women) who underwent completion pneumonectomy for lung cancer between 1995 and 2009 in one of two thoracic surgery departments. Most were current or former smokers (n = 41; 89%) and did not undergo chemotherapy (n = 38; 83%) or radiotherapy (83%) before surgery.
  
  
  RESULTS
  Complications after surgery were respiratory failure (n = 11; 24.4%), bronchopleural fistula (n = 6; 13%, with no side preference), and empyema (n = 6; 13%). Blood transfusion was necessary for 43% of the cases (n = 20). The day 90 death rate was 15.2% (n = 7). Postoperative staging showed mostly limited disease. Ten patients (21.7%) underwent operation for a second primary cancer, 25 for local recurrence (54.3%), five for microscopically incomplete resection, and six for other reasons. Median overall survival after completion surgery was 30 months (median follow-up: 46.5 months). Among the 15 living patients (33%), 11 are free of disease (24%). In a Cox regression model, factors negatively influencing overall survival were: age older than 65 years (odds ratio [OR] = 2.47; p = 0.012), current smoker status (OR = 2.285; p = 0.033), postoperative pulmonary (OR = 5.144; p = 0.004), cardiac (OR = 3.404; p = 0.033), or parietal wound complications (OR = 5.439; p = 0.016).
  
  
  CONCLUSIONS
  Despite its increased postoperative complications and mortality compared with standard pneumonectomy, completion pneumonectomy offers encouraging long-term results. Five main factors seem predictive of shorter overall survival.
authors.affiliation: Thoracic Surgery Department, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 avenue du doyen Lépine, Bron, France. mayeul.tabutin@chu-lyon.fr
authors.forename: Mayeul
authors.initials: M
authors.lastname: Tabutin
authors.forename: Sébastien
authors.initials: S
authors.lastname: Couraud
authors.forename: Benoit
authors.initials: B
authors.lastname: Guibert
authors.forename: Pierre
authors.initials: P
authors.lastname: Mulsant
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Souquet
authors.forename: François
authors.initials: F
authors.lastname: Tronc
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D018287:Carcinoma, Large Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate