Is pneumonectomy still relevant for non-small cell lung cancer? Long-term overall survival from a 15-year experience

Pneumonectomy has long been shown to be curative for lung cancer but may lead to several acute and chronic adverse physiologic changes. Limited data are available on long-term follow-up of patients who have undergone this procedure. We sought to evaluate whether pneumonectomy is still a valuable therapeutic procedure when it is the only curative approach available and to report on long-term survival after the procedure as well as operative mortality and morbidity.

The primary outcome of our study was long-term overall survival after pneumonectomy. Secondary outcomes were operative mortality and morbidity at 30 days and 90 days, and identification of risk factors influencing operative mortality and overall survival. We conducted a single-institution retrospective study involving all patients who underwent a pneumonectomy for non-small cell lung cancer between Jan. 1, 2005, and Dec. 31, 2019.

We included 277 patients; 59.6% were male and the mean age was 64 years. The median survival time was 3.2 years. Overall survival rates at 1, 5, 10, and 15 years were 73.3%, 42.8%, 29.7%, and 26.3%, respectively. Univariate and multivariate analyses on survival showed that age, tobacco exposure, advanced oncologic stage, and bronchopleural fistula were associated with a worse prognosis. Mortality at 30 days and 90 days was 6.5% and 11.2%, respectively. Neoadjuvant therapy and right-sided pneumonectomy did not increase the risk of death, whereas intrapericardial pneumonectomy, pulmonary complications, atrial fibrillation, and bronchopleural fistula did increase it.

Pneumonectomy remains a valuable therapeutic option when treating patients with non-small cell lung cancer with a curative intent with regard to their overall survival, but it remains a procedure with high perioperative morbidity and mortality.