Details

Autor(en) / Beteiligte

• Thomas, Pascal A., MD, FECTS
• Berbis, Julie, MD
• Baste, Jean-Marc, MD
• Le Pimpec-Barthes, Françoise, MD
• Tronc, François, MD
• Falcoz, Pierre-Emmanuel, MD
• Dahan, Marcel, MD
• Loundou, Anderson, PhD

Titel

Pneumonectomy for lung cancer: Contemporary national early morbidity and mortality outcomes

Ist Teil von

• The Journal of thoracic and cardiovascular surgery, 2015, Vol.149 (1), p.73-83

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• Objective The study objective was to determine contemporary early outcomes associated with pneumonectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database (EPITHOR). Methods After discarding inconsistent files, a group of 4498 patients who underwent elective pneumonectomy for primary lung cancer between 2003 and 2013 was selected. Logistic regression analysis was performed on variables for mortality and major adverse events. Then, a propensity score analysis was adjusted for imbalances in baseline characteristics between patients with or without neoadjuvant treatment. Results Operative mortality was 7.8%. Surgical, cardiovascular, pulmonary, and infectious complications rates were 14.9%, 14.1%, 11.5%, and 2.7%, respectively. None of these complications were predicted by the performance of a neoadjuvant therapy. Operative mortality analysis, adjusted for the propensity scores, identified age greater than 65 years (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5-2.9; P  < .001), underweight body mass index category (OR, 2.2; 95% CI, 1.2-4.0; P  = .009), American Society of Anesthesiologists score of 3 or greater (OR, 2.310; 95% CI, 1.615-3.304; P  < .001), right laterality of the procedure (OR, 1.8; 95% CI, 1.1-2.4; P  = .011), performance of an extended pneumonectomy (OR, 1.5; 95% CI, 1.1-2.1; P  = .018), and absence of systematic lymphadenectomy (OR, 2.9; 95% CI, 1.1-7.8; P  = .027) as risk predictors. Induction therapy (OR, 0.63; 95% CI, 0.5-0.9; P  = .005) and overweight body mass index category (OR, 0.60; 95% CI, 0.4-0.9; P  = .033) were protective factors. Conclusions Several risk factors for major adverse early outcomes after pneumonectomy for cancer were identified. Overweight patients and those who received induction therapy had paradoxically lower adjusted risks of mortality.