Postoperative morbidity and mortality after pneumonectomy: a 30-year experience of 2064 consecutive patients

Our plain-English summary of Postoperative morbidity and mortality after pneumonectomy: a 30-year experience of 2064 consecutive patients, by C. Pricopi, P. Mordant, C. Rivera, et al (Interactive Cardiovascular and Thoracic Surgery, 2015).

The study

• Authors: C. Pricopi, P. Mordant, C. Rivera, A. Arame, C. Foucault, A. Dujon, F. Le Pimpec Barthes, M. Riquet
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2015;20(3):316-21
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: We examined whether the changes in clinical practice with time correlated with the changes in the 90-day mortality following pneumonectomy.

Methods: The clinical records of consecutive patients undergoing pneumonectomy in two French centres from 1980 to 2009 were prospectively collected. The 90-day postoperative course was retrospectively studied according to clinical characteristics, underlying diseases, type of surgery and time-period (1980-1989; 1990-1999 or 2000-2009).

Results: Pneumonectomy was performed in 2064 patients (right n = 948, males n = 1758, mean age 60 ± 10 years). Indications were non-small-cell lung cancer (n = 1805, 87%), mesothelioma (n = 39, 1.8%), other tumours (n = 132, 6.3%) and non-tumour disease (n = 88, 4.2%). The 30- and 90-day mortality were 17.4 and 7.2% in the first decade, 22.3 and 9% in the second decade and 26.4 and 7.3% in the third decade, respectively. In multivariate analysis, older age, right-sided resection, T3-T4 and N2 lung cancer disease were significantly associated with increased overall 90-day mortality, whereas surgery during the last decade was associated with a better outcome when compared with the first decade (RR: 0.63, 95% confidence interval: 0.50-0.80, P = 0.045). When focusing on patients with non-small-cell lung cancer (NSCLC), the 90-day mortality following induction therapy and pneumonectomy decreased from 21.9% in the 1980s to 8.2% in the 2000s (P = 0.038), while such decrease was not found in patients without induction therapy or in patients undergoing a lobectomy.

Conclusions: The overall 90-day mortality after pneumonectomy was not significantly modified over the last 30 years, while the 90-day mortality after induction therapy followed by pneumonectomy for NSCLC decreased significantly.

© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

In plain English

This study reviewed records of 2064 patients who had a whole lung removed (pneumonectomy) at two French centres from 1980 to 2009. It did not study asbestos exposure. Most had non-small-cell lung cancer; 39 had mesothelioma. 8.0% died within 90 days and 21.4% had non-fatal complications within 30 days. Deaths within 90 days were more frequent after right-sided than left-sided surgery (11.5% vs 5.1%). In the 39 mesothelioma patients, 90-day mortality was 10.3%, which the authors reported was not significantly different, but empyema (chest infection) without fistula was more frequent (17.9%). Complications, mainly heart rhythm disturbances, rose over the decades, while death rates stayed stable. Older age, right-sided surgery and more advanced lung cancer were linked to higher 90-day mortality. In non-small-cell lung cancer patients given induction therapy before pneumonectomy, 90-day mortality fell from 21.9% in the 1980s to 8.2% in the 2000s; no such fall was seen without induction therapy or after lobectomy. The authors concluded that overall 90-day mortality did not change significantly. They noted the retrospective design as a limitation. Some of the article's figures contradict each other.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of consecutive surgical records from two centres, with logistic regression analysis of 90-day mortality
• Who was studied: 2064 patients who had a pneumonectomy at Georges Pompidou European Hospital (Paris) and Cedar Surgery Centre (Bois Guillaume), France, from January 1980 to December 2009. 1758 were male (85.2%) and the mean age was 60 years. Indications were non-small-cell lung cancer (1805), mesothelioma (39), other tumours (132) and non-tumour disease (88).
• Exposure: No asbestos or fiber exposure was studied. The study examined outcomes of pneumonectomy by diagnosis, side, time-period and, for lung cancer, induction therapy before surgery. The 39 mesothelioma patients had pleuro-pneumonectomy.
• Main results:
  • In all 2064 patients, 90-day mortality was 8.0% and 30-day morbidity was 21.4%.
  • Postoperative deaths were more frequent after right pneumonectomy, with 90-day mortality of 109 of 948 (11.5%) on the right vs 57 of 1116 (5.1%) on the left. Non-lethal complications were more frequent after left pneumonectomy.
  • 90-day mortality by diagnosis was 4.5% for non-tumoural disease, 7.8% for NSCLC, 10.3% for mesothelioma (4 of 39) and 13.6% for other tumoural disease (P = 0.0035).
  • In mesothelioma patients, postoperative mortality was not significantly different from other patients. The rate of empyema without fistula was higher: 7 of 39 (17.9%), P = 0.0066.
  • Postoperative complications increased over time, mainly from more cardiac arrhythmias. 30-day morbidity was 17.4%, 22.3% and 26.4% across the three decades (P less than 0.001). 30- and 90-day mortality remained stable; 90-day mortality was 7.2%, 9% and 7.3% (P = 0.32).
  • In multivariate analysis, age (RR 1.04 per year, 1.03 to 1.05), time-period, side of resection (left vs right RR 0.50, 0.42 to 0.58), and in NSCLC T3 to T4 disease (RR 1.66, 1.42 to 1.95) and N2 disease (RR 1.91, 1.57 to 2.33) were independent prognostic factors for 90-day mortality. For surgery in 2000 to 2009 vs 1980 to 1989, Table 5 gives RR 0.63 (95% confidence interval 0.50 to 0.80), with a P-value printed as 0.45.
  • In NSCLC patients who had induction therapy followed by pneumonectomy, 90-day mortality fell from 21.9% in the 1980s to 8.2% in the 2000s (P = 0.038). No such decrease was found without induction therapy, or after lobectomy.
• The authors' conclusion: The authors concluded that overall 90-day mortality after pneumonectomy did not change significantly over 30 years, but 90-day mortality after induction therapy followed by pneumonectomy improved significantly.
• Limitations the authors state:
  • Retrospective design, and no data on preoperative general risk factors such as nutritional status and pulmonary function.
  • The authors said the lower mortality after induction therapy in the last decade probably reflects selection bias, with only very fit patients referred for surgery.
  • The authors said the rise in arrhythmias may reflect an ageing population and possible diagnosis bias.

Topics

Medical terms in this study, explained in our Lexicon: Pneumonectomy, Lung Cancer, Mesothelioma, Multivariate Analysis, confidence interval.

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