Which is the Role of Pneumonectomy in the Era of Parenchymal-Sparing Procedures? Early/Long-Term Survival and Functional Results of a Single-Center Experience

Our plain-English summary of Which is the Role of Pneumonectomy in the Era of Parenchymal-Sparing Procedures? Early/Long-Term Survival and Functional Results of a Single-Center Experience, by A. Janet-Vendroux, M. Loi, A. Bobbio, et al (Lung, 2015).

The study

• Authors: A. Janet-Vendroux, M. Loi, A. Bobbio, F. Lococo, A. Lupo, P. Ledinot, P. Magdeleinat, N. Roche, D. Damotte, J.F. Regnard, M. Alifano
• Journal: Lung
• Published: 2015;193(6):965-73
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: Despite the increasing adoption of parenchymal-sparing procedures, pneumonectomy is still necessary in several pleural and pulmonary (benign or malignant) diseases. We reviewed clinical data of a large cohort of patients treated by pneumonectomy with the aim of better define its impact on early and long-term results.

Methods: Clinical and pathological characteristics of all consecutive patients treated by pneumonectomy between January 2005 and May 2012 were retrospectively reviewed. Thirty- and 90-day mortality, as well as long-term survival was assessed. Factors associated to long-term survival were analyzed by univariate and multivariate analyses. Evaluation of quality of life was carried out by a standard questionnaire (SF-12) administrated by phone to patients surviving beyond 1 year.

Results: A total of 398 patients (293 men; mean age 61 ± 10.9 years) were operated on in the study period. Indication was malignancy in 380 patients (350 primary lung cancers). Thirty-day mortality was 9 % (right: 12.6 % vs. left: 6.3 %, p = 0.013), significantly correlating with age (p = 0.021), comorbidities (p = 0.034), PS > 1 (p = 0.018), preoperative dyspnea (p = 0.0013), and FEV1 (p = 0.0071). Overall 1-, 3-, 5-, and 7-year survival rates were 76.6, 46.6, 34.4, and 29.2 %. In case of primary lung cancer, these figures were 76.8, 46.4, 34.5, and 29.7 %. At univariate analysis, a less favorable survival was associated to PS > 1 (p = 0.0078), right side (p = 0.044), occurrence of postoperative complications (p = 0.00079), and T3-4 status (p = 0.013). At multivariate analysis, PS > 1, right side, and occurrence of postoperative complications were identified as independent worse prognostic factors. SF12 physical score was 39.1 ± 9.0 and was correlated to the presence of preoperative symptoms (p = 0.013). Mental score was 50.68 ± 9.63 and was correlated to preoperative FEV1/FVC ratio (p = 0.023) and side of disease (p = 0.023).

Conclusion: In current practice, pneumonectomy is still performed for malignancy, sometimes after induction treatment. High postoperative morbidity and mortality are observed; however, at a farer interval time point, long-term survival with preserved quality of life can be observed.

In plain English

This retrospective review covered 398 consecutive pneumonectomy (whole-lung removal) patients at one Paris hospital, January 2005 to May 2012. Most (350) had non-small cell lung cancer; 27 had malignant pleural mesothelioma, all epithelioid. The article does not report asbestos-exposure histories or separate outcomes for mesothelioma patients. Overall, 9% died within 30 days or during the hospital stay: 12.57% (22 of 175) after right-sided and 6.33% (14 of 221) after left-sided operations; a table lists 223 left-sided operations. Survival was 76.6% at 1 year (71.85 to 80.71), 34.4% at 5 years (28.91 to 40.38) and 29.2% at 7 years (23.56 to 35.64); median 29 months. In lung cancer patients, the authors named performance status above 1, right-sided surgery and postoperative complications as independent factors of worse 5-year survival, though the right-side p value (printed as 0.052 and 0.050) was not below their 0.05 threshold. Survivors' average SF-12 quality-of-life scores were 39.11 physical and 50.68 mental. The authors concluded that early complication and death rates are high but long-term survival with preserved quality of life can be observed. They named the retrospective design as a limitation.

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 single-center review of consecutive patients (case series), with a quality-of-life questionnaire given to survivors
• Who was studied: 398 consecutive patients who underwent pneumonectomy at the Department of Thoracic Surgery, Cochin Hospital, Paris, from January 2005 to May 2012. Indications were non-small cell lung cancer in 350, malignant pleural mesothelioma in 27 (all epithelioid), lung metastasis in 3, non-malignant destroyed lung or bronchiectasis in 6, and salvage surgery in 12.
• Exposure: The study examined outcomes of a surgical procedure, pneumonectomy (right or left, some with sleeve resection, some after induction chemotherapy). The article does not report patients' asbestos-exposure histories.
• Main results:
  • 30-day mortality (within 30 days of surgery or during the hospital stay) was 9% in all patients and 8.6% in non-small cell lung cancer patients
  • The results section gives 30-day mortality of 12.57% (22/175) after right pneumonectomy and 6.33% (14/221) after left pneumonectomy. Table 1 lists 223 left pneumonectomies, not 221.
  • In patients given induction therapy before surgery, 30-day mortality was 7.21% (8/111). In patients treated with surgery alone it was 9.36% (22/235). The difference was not statistically significant (p = 0.51).
  • Bronchopleural fistula occurred in 14 of 398 patients (3.5%)
  • Overall survival in the entire population was 87.6% at 3 months, 76.6% (71.85 to 80.71) at 1 year, 46.6% (41.13 to 52.1) at 3 years, 34.4% (28.91 to 40.38) at 5 years and 29.2% (23.56 to 35.64) at 7 years. Median survival was 29 months.
  • In non-small cell lung cancer patients, survival was 46.4% at 3 years, 34.5% at 5 years and 29.7% at 7 years
  • In non-small cell lung cancer patients, the authors identified three independent factors of poor 5-year survival in multivariate analysis. These were performance status above 1 (p = 0.024; RR 1.59, 1.06 to 2.37) and right operative side (p = 0.052 in the text, 0.050 in Table 2; RR 1.34, 1.00 to 1.79). The third was postoperative complications (p = 0.0036 in the text, 0.004 in Table 2; RR 1.55, 1.15 to 2.07). The right-side p value is not below the stated 0.05 threshold.
  • Among survivors, the average SF-12 physical score was 39.11 plus or minus 9.037
  • Among survivors, the average SF-12 mental score was 50.68 plus or minus 9.63
• The authors' conclusion: The authors concluded that high postoperative morbidity and mortality are observed after pneumonectomy, but that at later time points long-term survival with preserved quality of life can be observed
• Limitations the authors state:
  • The survival analyses were done retrospectively and share the usual biases of retrospective studies

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pneumonectomy, Quality of Life, Lung Cancer, Dyspnea, FEV1, Multivariate Analysis, FEV1/FVC Ratio.

Related studies

• Should we continue to offer extrapleural pneumonectomy to selected mesothelioma patients? A single center experience comparing surgical and non-surgical management — M. Baud, A. Bobbio, et al. (2014)
• Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases — L.S. Kyang, N.A. Alzahrani, et al. (2019)
• p40 is the best marker for diagnosing pulmonary squamous cell carcinoma: comparison with p63, cytokeratin 5/6, desmocollin-3, and sox2 — T. Tatsumori, K. Tsuta, et al. (2014)
• Long-term survival after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group Stage T3-T4) non-sarcomatoid malignant pleural mesothelioma — A. Nakas, E. von Meyenfeldt, et al. (2012)
• Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy — T.C. Chua, W. Liauw, et al. (2011)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: a single institution experience and long term follow up — P. Malekzadeh, M. Good, et al. (2021)

Browse more research in Lung, or return to medical research.