Late Survival and Hospital Trajectory After Pneumonectomy for Non-small Cell Lung Cancer

Lung cancer may require complex interventions such as pneumonectomy. This study investigates late survival after pneumonectomy and assesses the need for late rehospitalizations.

We performed a retrospective analysis of 479 consecutive patients with lung cancer undergoing pneumonectomy at our institution between 2005 and 2015. Survival was assessed at 3, 5, and 8 years and Cox multivariate analysis was used to identify independent predictors. The National anonymized medico-economic database (PMSI) was used to study early and late (up to 10 years after surgery) postpneumonectomy hospital trajectories (excluding routine follow-up visits) of patients in the last 2 years of the study period (n = 179).

The mean age of patients was 62.7 ± 9.9 years and 74.9% were men; 56.18% had FEV1 below 80% of predicted. Stage III accounted for 62.84% of patients. Overall survival at 3, 5 and 8 years was 58.9%, 47.6% and 39.6%, respectively. Male sex, active tobacco smoking, Charlson Comorbidity Index >5, stage III-IV, and occurrence of Clavien Dindo≥3 postoperative complications were independent predictors of worse survival. After pneumonectomy, a total of 4845 hospitalisations were recorded in 179 patients, 886 for postoperative adjuvant treatments. Forty-five out of the 179 patients had a late hospitalisation for lung cancer recurrence, with an average delay of 23.3 months. There were 25 readmissions, involving 20/179 patients, for respiratory failure, whereas 15/179 patients were readmitted for cardiac failure. In addition, 9/179 patients were readmitted for a new nonpulmonary cancer.

Despite the strong physiological impact, pneumonectomy has satisfactory short and long-term results.