title: Pneumonectomy for benign disease: indications and postoperative outcomes, a nationwide study.
abstract: OBJECTIVE
  Pneumonectomy for benign disease is rare but is thought to have a higher more postoperative morbidity and mortality than when performed for lung cancer. We questioned this by assessing and analysing indications and postoperative outcomes of patients who underwent this type of resection.
  
  
  METHODS
  We used Epithor, the French national thoracic database including 91 public and private institutions with more than 220 000 procedures. We prospectively collected data of 5975 patients who underwent pneumonectomy between January 2003 and June 2013. The 321 patients (5.4%) who underwent pneumonectomy (n = 201) or completion pneumonectomy (n = 120) for benign disease were compared with those treated for malignant disease.
  
  
  RESULTS
  The patients' mean age was 55.2 years (53.5; 56.8) for benign indications vs 61.6 years (61.4; 61.9) for malignant disease; the sex ratio was 1.8 (207 males) and 4 (4543 males), respectively; 53% of patients (n = 169) had an American Society of Anesthesiologist (ASA) score of ≥3 vs 29% (n = 1598) for malignant disease. For benign disease, most frequent indications were infection or abscess (n = 114, 37.1%), post-tuberculosis destroyed lung (n = 47, 15.3%), aspergillosis or aspergilloma (n = 33, 10.7%), bronchiectasis (n = 41, 13.3%), haemorrhage (n = 26, 8.5%) and benign tumour (n = 20, 6.5%). Complications occurred in 53% (n = 170) of patients and the postoperative in-hospital mortality rate was 22.1% (n = 71). These results were significantly worse than those for malignant indications: 38.9% (n = 2198) of morbidity (P < 0.0001) and 5.1% (n = 288) of in-hospital mortality (P < 0.0001). For benign disease, there was no difference in fistula formation regarding side (P = 0.07) or type of resection (P = 0.6). Morbidity was higher for completion pneumonectomy: 62.5 vs 47.3% (P = 0.008). Mortality was significantly higher in case of resection for infection or abscess (P = 0.01) and for haemorrhage (P = 0.002). Emergency procedures were associated with worse postoperative outcomes (P < 0.0001).
  
  
  CONCLUSIONS
  Pneumonectomy for benign disease achieves cure with very high levels of morbidity and mortality. This type of surgical treatment should be considered as a salvage procedure.
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France EPITHOR Group, French Society of Thoracic and Cardiovascular Surgery, Paris, France caroline.rivera@egp.aphp.fr krorivera@yahoo.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rivera
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Alex
authors.initials: A
authors.lastname: Arame
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Ciprian
authors.initials: C
authors.lastname: Pricopi
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mangiameli
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Abdennadher
authors.affiliation: EPITHOR Group, French Society of Thoracic and Cardiovascular Surgery, Paris, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.affiliation: General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec Barthes
mesh_terms: D000038:Abscess / Q000601:surgery; D001987:Bronchiectasis / Q000601:surgery; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D008172:Lung Diseases, Fungal / Q000601:surgery; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Benign; Database; Morbidity; Mortality; Pneumonectomy