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Does pneumonectomy for lung cancer adversely influence long-term survival?
1Departments of Surgery and Health Studies, The University of Chicago, Chicago, IL 60637, USA. mferguso@surgery.bsd.uchicago.edu
The Journal of Thoracic and Cardiovascular Surgery
|March 1, 2000
Summary
Pneumonectomy does not significantly impact long-term survival in lung cancer patients after accounting for other factors. Further randomized trials are needed to confirm these findings on lung cancer resection outcomes.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Pneumonectomy carries higher operative mortality, leading to increased use of lung-sparing operations like sleeve lobectomy.
- The long-term survival impact of pneumonectomy versus lung-sparing procedures for non-small cell lung cancer remains unclear.
Purpose of the Study:
- To compare the long-term survival outcomes between patients undergoing pneumonectomy and those undergoing lung-sparing operations (lobectomy/bilobectomy) for non-small cell lung cancer.
Main Methods:
- Retrospective review of 442 patients with non-small cell lung cancer undergoing lobectomy/bilobectomy (340) or pneumonectomy (102) between 1980 and 1998.
- Survival curves compared using log-rank test; logistic regression and Cox proportional hazards models used for covariate analysis.
Main Results:
- Operative mortality was 7.0% for lobectomy/bilobectomy and 12% for pneumonectomy.
- Unadjusted median survival was worse for pneumonectomy in Stage II (17.9 vs 36.3 months) and Stage III (11.7 vs 21.3 months).
- After adjusting for age, tumor status, nodal status, and FEV1, no significant difference in survival was detected between the surgical approaches (HR 1.21; 95% CI 0.88-1.68).
Conclusions:
- Pneumonectomy does not appear to have a significant long-term adverse effect on survival when adjusted for prognostic factors.
- Further randomized clinical trials are necessary to definitively establish the long-term survival impact of pneumonectomy versus lung-sparing resections.