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J Thorac Cardiovasc Surg. 2012 Jan;143(1):55-63. doi: 10.1016/j.jtcvs.2011.09.002. Epub 2011 Nov 4.

An analysis, systematic review, and meta-analysis of the perioperative mortality after neoadjuvant therapy and pneumonectomy for non-small cell lung cancer.

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  • 1Section of Thoracic Surgery, School of Medicine, Yale University, New Haven, Conn 06520, USA. anthony.kim@yale.edu

Abstract

OBJECTIVE:

Pneumonectomy after neoadjuvant therapy remains controversial.

METHODS:

A systematic PubMed search was performed for original articles from 1990 through 2010 describing pneumonectomy after neoadjuvant therapy. Specific data on 30-day and 90-day perioperative mortalities were abstracted from these articles. Meta-analysis compared 30-day mortality between right and left pneumonectomy with a fixed-effects model. Comparison between 30-day and 90-day mortalities was also performed.

RESULTS:

The search strategy yielded 27 studies. Overall, 30-day and 90-day perioperative mortalities were 7% and 12%, respectively. Among 15 studies providing side-specific 30-day mortality, cumulative mortalities were 11% and 5% for right and left pneumonectomies, respectively. In the meta-analysis that included 10 studies, 30-day mortality for right pneumonectomy remained greater than for left pneumonectomy (odds ratio, 1.97; 95% confidence interval, 1.11-3.49; P = .02). Among 6 studies providing side-specific 90-day mortality, cumulative mortalities were 20% and 9% for right and left pneumonectomies, respectively. In the meta-analysis that included 4 studies, 90-day mortality for right pneumonectomy was greater than for left pneumonectomy (odds ratio, 2.01; 95% confidence interval, 1.09-3.72; P = .03). Among 11 studies providing both 30-day and 90-day mortalities, mortality difference was 5% (95% confidence interval, 4%-7%, P < .0001). Pulmonary complications were the most common cause of 30-day and 90-day deaths.

CONCLUSIONS:

Right pneumonectomy is associated with significantly higher 30-day and 90-day mortalities after neoadjuvant therapy than left pneumonectomy. Also, 90-day mortality for all pneumonectomies appears to be greater than expected, suggesting that the 30-day mortality figure may inadequately assess the perioperative mortality.

Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

PMID:
22056364
[PubMed - indexed for MEDLINE]
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