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Ann Thorac Surg 2009;88:937-944. doi:10.1016/j.athoracsur.2009.04.102
© 2009 The Society of Thoracic Surgeons
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Anthony W. Kim
William H. Warren
Michael J. Liptay
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Right arrow Lung - cancer

Original Articles: General Thoracic

Pneumonectomy After Chemoradiation Therapy for Non-Small Cell Lung Cancer: Does "Side" Really Matter?

Anthony W. Kim, MDa, L. Penfield Faber, MDa, William H. Warren, MDa, Sanjib Basu, PhDa, Sean C. Wightman, BAa, James A. Weber, BAa, Philip Bonomi, MDb, Michael J. Liptay, MDa,*

a Division of Thoracic Surgery, Rush University Medical Center, Chicago, Illinois
b Section of Medical Oncology, Rush University Medical Center, Chicago, Illinois

Accepted for publication April 22, 2009.

* Address correspondence to Dr Liptay, University Thoracic Surgeons, 1725 W Harrison St, Ste 774, Chicago, IL 60612 (Email: michael_liptay{at}rush.edu).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: The long-term benefits and risks of pneumonectomy after neoadjuvant chemoradiation therapy remain controversial. This study evaluated our experience with pneumonectomy for advanced non-small cell lung cancer (NSCLC) after concurrent chemoradiation therapy.

Methods: We reviewed medical records from patients undergoing concurrent chemoradiation therapy, followed by pneumonectomy (1983 to 2007). Clinical variables affecting Kaplan-Meier survival were analyzed.

Results: After chemoradiation therapy, 129 pneumonectomies (right, 65; left, 64) were performed. Postoperative pathologic stages were complete responders (CR), 21; I, 23; II, 19; III, 62; and IV, 4. The 90-day perioperative mortality was 20% (13 of 65) after right-sided pneumonectomy vs 9% (6 of 64) after left-sided pneumonectomy (p = 0.084). Complications occurred in 33% (43 of 129), including bronchopleural fistula in 12% (16 of 129) and acute respiratory distress syndrome in 2% (3 of 129). Overall 5-year survival was 33%. Survival was 32% for right-sided sections vs 34% for left-sided. CR patients had a 5-year survival of 48%. Survival of patients with postoperative N0, N1, and N2 nodes was 42%, 26%, and 28%, respectively. Multivariate analysis showed the development of major complications negatively affected 5-year survival for patients undergoing right-sided pneumonectomy (hazard ratio, 0.462; p = 0.0399).

Conclusions: Pneumonectomy after concurrent chemoradiation therapy achieved long-term survival. When neoadjuvant therapy resulted in complete response or nodal downstaging, survival was improved. The risk of early perioperative death and complications was higher for right-sided procedures, but long-term survival did not differ between right- and left-sided pneumonectomy. Major complications negatively affected 5-year survival with right-sided pneumonectomies.






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