title: Pneumonectomy: risk factor or innocent bystander?
abstract: BACKGROUND
  Pneumonectomy is associated with a higher operative mortality rate and worse 5-year survival after resection for non-small-cell lung cancer, compared to lobectomy. We investigated whether pneumonectomy is an independent risk factor for hospital mortality and poor long-term survival, after risk factor adjustment.
  
  
  METHODS
  We analyzed a prospectively validated thoracic surgery database. Kaplan-Meier survival curves were constructed for patients who had undergone lobectomy (n = 1484) or pneumonectomy (n = 266). Logistic and Cox multivariate regression analysis and propensity matching were performed on hospital mortality and long-term survival data.
  
  
  RESULTS
  Univariate analysis demonstrated that pneumonectomy was a significant risk factor for hospital death (p = 0.02) and long-term survival (p < 0.001). Logistic regression failed to demonstrate pneumonectomy as a risk factor for hospital mortality. Cox regression analysis failed to identify pneumonectomy as a statistically significant risk factor. Propensity analysis (n = 266 in each group with 1:1 matching) demonstrated that pneumonectomy was not associated with hospital mortality (p = 0.37) or poorer long-term survival (p = 0.19) compared to lobectomy.
  
  
  CONCLUSIONS
  Pneumonectomy is not an independent risk factor for hospital mortality or long-term survival, after adjustment for confounding factors.
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Warwick
authors.forename: Neeraj
authors.initials: N
authors.lastname: Mediratta
authors.forename: Michael
authors.initials: M
authors.lastname: Shackcloth
authors.forename: Richard
authors.initials: R
authors.lastname: Page
authors.forename: James
authors.initials: J
authors.lastname: McShane
authors.forename: Matthew
authors.initials: M
authors.lastname: Shaw
authors.forename: Michael
authors.initials: M
authors.lastname: Poullis
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015986:Confounding Factors, Epidemiologic; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Carcinoma; Lung neoplasms; Pneumonectomy; Risk factors; Survival; non-small-cell lung