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J Thorac Cardiovasc Surg. 2015 Jan;149(1):73-82. doi: 10.1016/j.jtcvs.2014.09.063. Epub 2014 Sep 28.

Pneumonectomy for lung cancer: contemporary national early morbidity and mortality outcomes.

Author information

1
Department of Thoracic Surgery, North Hospital - APHM, Aix-Marseille University, Marseille, France. Electronic address: pathomas@ap-hm.fr.
2
Department of Public Health, North Hospital, EA 3279 Research Unit, Aix-Marseille University, Marseille, France.
3
Department of General and Thoracic Surgery, Rouen, France.
4
Department of Thoracic Surgery, HEGP, Paris, France.
5
Department of Thoracic Surgery, Louis Pradel Hospital, Lyon, France.
6
Department of Thoracic Surgery, NHC, Strasbourg, France.
7
Department of Thoracic Surgery, Larrey Hospital, Toulouse, France.
8
Methodological Assistance to Clinical Research, Faculty of Medicine, Department of Public Health, Marseille, France.

Abstract

OBJECTIVE:

The study objective was to determine contemporary early outcomes associated with pneumonectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database (EPITHOR).

METHODS:

After discarding inconsistent files, a group of 4498 patients who underwent elective pneumonectomy for primary lung cancer between 2003 and 2013 was selected. Logistic regression analysis was performed on variables for mortality and major adverse events. Then, a propensity score analysis was adjusted for imbalances in baseline characteristics between patients with or without neoadjuvant treatment.

RESULTS:

Operative mortality was 7.8%. Surgical, cardiovascular, pulmonary, and infectious complications rates were 14.9%, 14.1%, 11.5%, and 2.7%, respectively. None of these complications were predicted by the performance of a neoadjuvant therapy. Operative mortality analysis, adjusted for the propensity scores, identified age greater than 65 years (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5-2.9; P < .001), underweight body mass index category (OR, 2.2; 95% CI, 1.2-4.0; P = .009), American Society of Anesthesiologists score of 3 or greater (OR, 2.310; 95% CI, 1.615-3.304; P < .001), right laterality of the procedure (OR, 1.8; 95% CI, 1.1-2.4; P = .011), performance of an extended pneumonectomy (OR, 1.5; 95% CI, 1.1-2.1; P = .018), and absence of systematic lymphadenectomy (OR, 2.9; 95% CI, 1.1-7.8; P = .027) as risk predictors. Induction therapy (OR, 0.63; 95% CI, 0.5-0.9; P = .005) and overweight body mass index category (OR, 0.60; 95% CI, 0.4-0.9; P = .033) were protective factors.

CONCLUSIONS:

Several risk factors for major adverse early outcomes after pneumonectomy for cancer were identified. Overweight patients and those who received induction therapy had paradoxically lower adjusted risks of mortality.

Comment in

PMID:
25439468
DOI:
10.1016/j.jtcvs.2014.09.063
[Indexed for MEDLINE]
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