1. A Hussain, S Qadri, Y Haqzad, M Chaudhry, A Cale, M Cowen, M Loubani.
Short And Long-term Outcomes of Pneumonectomy For Lung Cancer: 15-Years Experience
A Hussain, S Qadri, Y Haqzad, M Chaudhry, A Cale, M Cowen, M Loubani.
 Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, United Kingdom
Background: Surgery is the most important therapeutic modality for the treatment of locally advanced and centrally located lung cancer. Surgical outcomes are normally reported as 30-day or 90-day mortality or 5-year survival. However, 10-years survival is rarely mentioned in the national data or international studies.
Methods: Patients included who underwent penumonectomy from January 1998 to February 2013, and their short and long-term outcomes were analysed till september2014. Thoracoscore was used to calculate the risk of in-hospital mortality. National Thoracic Surgery Activity & Outcomes Report 2011 by Society for cardiothoracic Surgery of Great Britain and Ireland demonstrated 6.5% mortality in pneumonectomy patients compare to 2 % in lobectomy for lung cancer and 7.9% vs. 2.4% mortality for non-lung cancer surgery respectively
Result: 306-patients underwent pneumonectomy mainly for lung cancer. 79% were male, median age was 64-years (22-82years) and 24% were ≥ 70-years. Operative mortality was 4.5% while predicted mortality was 8%. However, operative mortality for cancer patients was 3.3% while reported national mortality for lung cancer is 6.5%. Only 2-patients died in hospital after pneumonectomy in the last 5 years. Half of the patients, who died in hospital, were ≥70-years while 29%(4-patients) died after urgent operation for non-malignant-disease. There was no in-hospital mortality in extra-pleural pneumonectomy (EPP) patients for malignant mesothelioma.
Mean and median survival for pneumonectomy was 4.8 years (95% CI years) and 2.2 years (95% CI years) respectively. Overall 1, 2, 3, 5 and 10-year survival rates were 70%, 54%, 42%, 32% and 20%. Long-term survival was better in female, patients with age <70 years, in left pneumonectomy and for squamous-cell-lung-cancer patients. However, age > 70 years, right pneumonectomy and urgent surgery for non-malignant disease were emerged as risk factors.
Conclusions: This retrospective single institutional study have shown that the mortality is 50% less than national mortality for pneumonectomy and significantly lower than that predicted by Thoracoscore. This confirms that pneumonectomy is still an effective and valuable modality in the treatment of advanced lung cancer with low operative mortality and good long-term survival especially in younger patients. It can be done safely with good short and long-term outcome by trained experienced surgeons.