Impact of Postoperative Complications on Long-term Survival in Patients With Non-small Cell Lung Cancer

Postoperative complications may adversely affect long-term outcomes after resection for non-small cell lung cancer (NSCLC), but their independent prognostic significance remains uncertain.

We retrospectively analyzed 1,690 patients who underwent lobectomy or segmentectomy for NSCLC at 12 institutions between January 2017 and December 2018. Patients were categorized into complication (n=313) and no-complication (n=1,377) groups. Overall survival (OS) and recurrence-free survival (RFS) were assessed using the Kaplan-Meier method and Cox proportional hazards models with backward elimination.

Postoperative complications occurred in 18.5% of patients. The most common complications were prolonged air leak (4.6%), atelectasis (3.7%), arrhythmia (3.4%), and pneumonia (3.0%). The 5-year OS and RFS were significantly lower in the complication group than in the no-complication group (82.1% vs. 88.5% and 80.1% vs. 87.9%, respectively; both p<0.001). In multivariable analysis, age ≥70 years [hazard ratio (HR=1.636, p=0.007)], positive lymph node metastasis (HR=1.942, p<0.001), non-adenocarcinoma histology (HR=1.633, p=0.005), postoperative complications (HR=1.657, p=0.005), and vascular invasion (HR=3.274, p<0.001) independently predicted worse OS. For RFS, age ≥70 years, male sex, pathological T2 or higher, positive lymph node metastasis, non-adenocarcinoma histology, lymphatic invasion, and vascular invasion were independent predictors, whereas postoperative complications were not.

Postoperative complications were independently associated with worse long-term OS, but not with RFS, after NSCLC resection. These findings suggest that postoperative complications may affect prognosis through mechanisms other than recurrence and highlight the importance of optimizing perioperative management.