title: Which is the Role of Pneumonectomy in the Era of Parenchymal-Sparing Procedures? Early/Long-Term Survival and Functional Results of a Single-Center Experience.
abstract: OBJECTIVE
  Despite the increasing adoption of parenchymal-sparing procedures, pneumonectomy is still necessary in several pleural and pulmonary (benign or malignant) diseases. We reviewed clinical data of a large cohort of patients treated by pneumonectomy with the aim of better define its impact on early and long-term results.
  
  
  METHODS
  Clinical and pathological characteristics of all consecutive patients treated by pneumonectomy between January 2005 and May 2012 were retrospectively reviewed. Thirty- and 90-day mortality, as well as long-term survival was assessed. Factors associated to long-term survival were analyzed by univariate and multivariate analyses. Evaluation of quality of life was carried out by a standard questionnaire (SF-12) administrated by phone to patients surviving beyond 1 year.
  
  
  RESULTS
  A total of 398 patients (293 men; mean age 61 ± 10.9 years) were operated on in the study period. Indication was malignancy in 380 patients (350 primary lung cancers). Thirty-day mortality was 9 % (right: 12.6 % vs. left: 6.3 %, p = 0.013), significantly correlating with age (p = 0.021), comorbidities (p = 0.034), PS > 1 (p = 0.018), preoperative dyspnea (p = 0.0013), and FEV1 (p = 0.0071). Overall 1-, 3-, 5-, and 7-year survival rates were 76.6, 46.6, 34.4, and 29.2 %. In case of primary lung cancer, these figures were 76.8, 46.4, 34.5, and 29.7 %. At univariate analysis, a less favorable survival was associated to PS > 1 (p = 0.0078), right side (p = 0.044), occurrence of postoperative complications (p = 0.00079), and T3-4 status (p = 0.013). At multivariate analysis, PS > 1, right side, and occurrence of postoperative complications were identified as independent worse prognostic factors. SF12 physical score was 39.1 ± 9.0 and was correlated to the presence of preoperative symptoms (p = 0.013). Mental score was 50.68 ± 9.63 and was correlated to preoperative FEV1/FVC ratio (p = 0.023) and side of disease (p = 0.023).
  
  
  CONCLUSIONS
  In current practice, pneumonectomy is still performed for malignancy, sometimes after induction treatment. High postoperative morbidity and mortality are observed; however, at a farer interval time point, long-term survival with preserved quality of life can be observed.
authors.affiliation: Department of Thoracic Surgery, Cochin Hospital, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Janet-Vendroux
authors.affiliation: Department of Thoracic Surgery, Cochin Hospital, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
authors.forename: Mauro
authors.initials: M
authors.lastname: Loi
authors.affiliation: Department of Thoracic Surgery, Cochin Hospital, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bobbio
authors.affiliation: Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Lococo
authors.affiliation: Department of Pathology, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Lupo
authors.affiliation: Department of Thoracic Surgery, Cochin Hospital, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Ledinot
authors.affiliation: Department of Thoracic Surgery, Cochin Hospital, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Magdeleinat
authors.affiliation: Department of Chest Disease, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.affiliation: Department of Pathology, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Damotte
authors.affiliation: Department of Thoracic Surgery, Cochin Hospital, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Regnard
authors.affiliation: Department of Thoracic Surgery, Cochin Hospital, 27, rue du Faubourg Saint Jacques, 75014, Paris, France. marco.alifano@cch.aphp.fr.
authors.forename: Marco
authors.initials: M
authors.lastname: Alifano
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D001987:Bronchiectasis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015897:Comorbidity; D004417:Dyspnea / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D015999:Multivariate Analysis; D059351:Organ Sparing Treatments; D011013:Pneumonectomy; D016016:Proportional Hazards Models; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014397:Tuberculosis, Pulmonary / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014797:Vital Capacity
keywords: NSCLC; Pneumonectomy; Quality of life