Tumor stage and early mortality for surgical resections in lung cancer

Postoperative mortality rates have been published in relation to operative procedure or preexisting pulmonary and extrapulmonary diseases. We analyzed our patients for the effect of the postoperative tumor stage on perioperative mortality.

Retrospective study of all thoracotomies for resections ( n=1281) in primary lung cancer from January 1987 to December 1997. Uni- and multivariate analysis was performed for operative procedure, mortality (30 and 90 days), tumor stage, sex, age, tumor localization, and completeness of resection. Radical resection was achieved in 91.9% of the patients.

Overall postoperative deaths occurred in 4% and 7.3% of patients after 30 and 90 days respectively. Depending on the operative procedure the mortality after segmental resection ( n=116) was 0.9% and 1.7%, lobectomy ( n=621) 3.0% and 5.7%, sleeve lobectomy ( n=152) 5.3% and 7.9%, and pneumonectomy ( n=314) 6.7% and 12.5%, respectively. Within 30 and 90 days postoperatively deaths occurred, respectively, in 0.8% and 1.0% of stage I patients ( n=493), 5.4% and 5.4% of stage II ( n=147), 4.9% and 8.8% of stage IIIa ( n=388), 7.2% and 16.6% of stage IIIb ( n=148), 8.9% and 20.5% and of stage IV ( n=114). Multivariate analysis showed postoperative tumor stage to be the factor most closely related to within the first 90 days.

Tumor stage but not type of resection is the strongest predictor of postoperative mortality in these subpopulations.