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Ann Thorac Surg 2007;84:952-958
© 2007 The Society of Thoracic Surgeons

Original Articles: General Thoracic

The Side of Pneumonectomy Influences Long-Term Survival in Stage I and II Non-Small Cell Lung Cancer

Carlos Simón, MDa,*, Nicolás Moreno, MDa, Rafael Peñalver, MDa, Guillermo González, MDa, Emilio Alvarez-Fernández, MDb, Federico González-Aragoneses, MDa Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery*

a Thoracic Surgery Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Anatomical Pathology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain

Accepted for publication April 23, 2007.

* Address correspondence to Dr Simón, Cirugía Torácica, Hospital Gregorio Marañón, C/ Dr. Esquerdo 46, Madrid, 28007, Spain (Email: cm_simon{at}telefonica.net).

Background: The impact of pneumonectomy as an independent factor on long-term survival after lung resection for centrally or locally advanced non-small cell lung cancer (NSCLC) remains controversial. The aim of this paper is to study the impact of pneumonectomy, and the influence of side of surgery, on long-term survival in patients with pathologic stage I and II NSCLC.

Methods: A retrospective review of a prospective multi-institutional database of patients operated on for lung cancer was undertaken. In all, 1,475 patients with pathologic stage I or II NSCLC were studied (421 underwent pneumonectomy; 1,054 had a lobectomy/bilobectomy). Survival and impact of side of surgery for pneumonectomy and lesser resection groups were analyzed and compared using the Kaplan-Meier method and the Cox proportional hazards model.

Results: Median survival was worse after pneumonectomy than after less extensive resections for patients overall (33 versus 57 months) and for those with stage I NSCLC (38 versus 70 months); however, median survival was better after pneumonectomy for stage II left tumors (55 versus 19 months). Pneumonectomy was an independent adverse determinant of survival for both stage I right tumors (p < 0.001) and stage I left tumors (p < 0.001), but was associated with improved survival for stage II left tumors (p = 0.009).

Conclusions: Pneumonectomy was found to be an independent determinant of survival in patients with stage I and II NSCLC, but results differed for right- and left-sided tumors. Further studies of survival comparing pneumonectomy with lesser resections should differentiate between right and left procedures.


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Invited commentary
Robert James Cerfolio
Ann. Thorac. Surg. 2007 84: 958. [Extract] [Full Text] [PDF]



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R. J. Cerfolio
Invited commentary
Ann. Thorac. Surg., September 1, 2007; 84(3): 958 - 958.
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