Do we still Perform Pneumonectomy?

Postoperative Morbidity and Mortality Following Pneumonectomy with Neoadjuvant Chemoradiation Versus adjuvant Chemotherapy Treatment: A Single Center Experience of 171 Consecutive Patients

Milton Saute1,2, Dan Aravot1,2, Aaron Allen1,2, Dov Flex1,2, Nir Peled1,2, Mordechai Kramer1,2, Yuri Peysakhovich1,2, Yaron Barac1,2


1Cardio-thoracic Surgery, Rabin Medical Center - Beilinson Hospital, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Israel

Pneumonectomy for locally advanced NSCLC remains a therapeutic challenge with overall survival of 5 years in best series hovering at 30%. The ideal treatment regimen remains under debate, specifically the role of this kind of surgery and its combination with oncologic neo adjuvant therapy. In this study, we reviewed long-term outcomes following pneumonectomy in advanced-stage NSCLC patients.

Methods:

171 consecutive patients underwent pneumonectomy for NSCLC from January 2005 to December 2015. The cohort is subdivided into two groups: 30 patients who received neo adjuvant chemo radiation (NA) and 141 patients who had upfront pneumonectomy followed by adjuvant treatment. The study groups were compared in relation to operative complexity and outcomes.

Results:

Patient cohort baseline characteristics were recorded and were found to be similar.

No statistically significant differences were found in surgery durations and hospitalization stay attesting no impact of the neo adjuvant on operation complexity. Nevertheless, neo adjuvant patients tended to have more interdepartmental transfers during subsequent hospitalizations. Moreover, neo adjuvant patients undergoing left-sided pneumonectomy required further hospitalization, when compared to left-sided pneumonectomy adjuvant patients attesting on patient morbidity. Upon examination of the postoperative course in regards to mortality, similar and equally high 30-day survival rates were observed. However, the 8-year survival rate among neo adjuvant patients was 40%, which proved two-fold greater than among adjuvant patients. Furthermore, when comparing IIIa patients the beneficiary effect of the neo adjuvant treatment was even more prominent as neo adjuvant patients survival rate in 8 years was 30% and for the adjuvant group was 0% in 5.5 years.

Conclusion:

We conclude that pneumonectomy following NA treatment has no effect of the operation complexity and mortality as deduced from the above surrogate markers. However, it does expose the patients to greater morbidity.