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Ann Thorac Surg. 2018 Nov 15. pii: S0003-4975(18)31657-6. doi: 10.1016/j.athoracsur.2018.10.009. [Epub ahead of print]

Right-sided vs Left-sided Pneumonectomy after Induction Therapy for Non-small-cell Lung Cancer.

Author information

1
Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
2
Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA. Electronic address: berry037@stanford.edu.

Abstract

BACKGROUND:

A right-sided pneumonectomy after induction therapy for non-small-cell lung cancer (NSCLC) has been shown to be associated with significant perioperative risk. We examined the impact of laterality on long-term survival after induction therapy and pneumonectomy using the National Cancer Data Base (NCDB).

METHODS:

Perioperative and long-term outcomes of patients who underwent pneumonectomy following induction chemotherapy with or without radiation from 2004-2014 in the NCDB were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis.

RESULTS:

During the study period, 1465 patients (right n=693 [47.3%], left n=772 [52.7%]) met inclusion criteria. Right-sided pneumonectomy was associated with significantly higher 30-day (8.2% [57/693] vs 4.2% [32/772], p< 0.01) and 90-day mortality (13.6% [94/693] vs 7.9% [61/772], p<0.01), and right-sided pneumonectomy was a predictor of higher 90-day mortality (OR 2.23, p<0.01). However, overall survival between right and left pneumonectomy was not significantly different in univariate (5-year survival 37.6% [95% CI: 0.34-0.42] vs 35% [95% CI: 0.32-0.39], log-rank p=0.94) or multivariable analysis (hazard ratio, 1.07 [95% CI: 0.92-1.25], p=0.40). In a propensity score-matched analysis of 810 patients, there were no significant differences in 5-year survival between the right- vs left-sided groups (34.7% [95% CI: 0.30-0.40] vs 34.1%, [95% CI: 0.29-0.39], log-rank p =0.86).

CONCLUSIONS:

In this national analysis, right-sided pneumonectomy after induction therapy was associated with a significantly higher perioperative but not worse long-term mortality compared to a left-sided procedure.

KEYWORDS:

“neoadjuvant induction therapy”; “pneumonectomy”

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