title: Standard versus extended pneumonectomy for lung cancer: what really matters?
abstract: BACKGROUND
  It is still not clear whether an intrapericardial pneumonectomy indicates a more advanced stage of the disease compared to a standard pneumonectomy.
  
  
  METHODS
  This was a retrospective study of 164 patients who underwent a pneumonectomy for lung cancer. The first group consisted of 82 patients who had a standard pneumonectomy and the second group was 38 patients who had a intrapericardial pneumonectomy, for both groups in the latest 5-year period. The third group was 44 patients with had a sleeve pneumonectomy in the latest 10-year period. The groups were compared in relation to the overall and stage-related survival, influence of T and N factors, operative morbidity and mortality. The statistics used were Kaplan-Meier, U-test, t-test, χ2 test.
  
  
  RESULTS
  There was no statistically significant difference in stage distribution between standard and intrapericardial pneumonectomies; stages I, II, IIIA and IIIB occurred for 10.9% vs. 2.6%, 30.5% vs. 26.3%, 46.4% vs. 65.8% and 12.2% vs. 5.3% of patients, respectively. For patients who had a sleeve pneumonectomy, stage IIIA was significantly more frequent. Although the overall survival (63.5% vs. 57.6%) and stage-related 5-year survival were better in the first compared to the second group, especially for stage IIIA (58.6% vs. 42.6%), these differences were not statistically significant. There were no significant differences in operative morbidity and mortality between groups 1 and 2, but both were significantly higher in the third group (35.7% and 15.9%).
  
  
  CONCLUSIONS
  An intrapericardial pneumonectomy does not always indicate a more advanced stage of the disease. The need for an intrapericardial pneumonectomy, either established preoperatively or during the operation, as a single factor, even for marginal surgical candidates, is not strong enough to reject these patients for surgery.
authors.affiliation: Clinic for Thoracic Surgery, Clinical Center of Serbia, University of Belgrade School of Medicine, Koste Todorovica 26, 11000 Belgrade, Serbia. profsubotic@gmail.com.
authors.forename: Dragan
authors.initials: D
authors.lastname: Subotic
authors.forename: Milan
authors.initials: M
authors.lastname: Savic
authors.forename: Nikola
authors.initials: N
authors.lastname: Atanasijadis
authors.forename: Milan
authors.initials: M
authors.lastname: Gajic
authors.forename: Jelena
authors.initials: J
authors.lastname: Stojsic
authors.forename: Marko
authors.initials: M
authors.lastname: Popovic
authors.forename: Vladimir
authors.initials: V
authors.lastname: Milenkovic
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Garabinovic
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
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