Long-term outcomes of completion pneumonectomy for non-small cell lung cancer

Sezen, Celal Buğra; Kocatürk, Celalettin; Bilen, Salih; Kalafat, Cem Emrah; Aker, Cemal; Karapınar, Kemal

doi:10.1080/00015458.2018.1527567

Cited by 5 publications

(7 citation statements)

References 25 publications

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“…Contrary to what is reported by other authors [ 3 , 6 , 8 ], in our series, patients with squamous cell carcinoma had worse survival ( p = 0.03), but it was not influenced by IT. Although some authors find differences in terms of survival between patients who had recurrence versus those who had a second primary lung cancer [ 10 , 13 , 35 ], in our study, like in those reported by other authors, there was no difference in survival based on the interval between operations ( p = 0.283) and also no difference between the two groups according to IT.…”

Section: Discussioncontrasting

confidence: 99%

“…This procedure has a higher morbidity and mortality than standard pneumonectomy [ 3 ] due to the high degree of surgical difficulty strongly associated with the previous surgery (i.e., presence of dense adhesions or fibrosis in the hilum structures). Published studies demonstrate an overall complication rate for CP performed for NSCLC ranging from 3.8% to 46.9% and operative mortality ranging from 0% to 17.6% [ 6 ]. Nevertheless, due to the rising incidence of lung cancer and thanks to the extended survival time after resection, the number of patients undergoing CP is increasing; moreover, the improvement in recent years of preoperative workup tests, anesthesia techniques, and postoperative management have led to a reduction in CP-related morbidity and mortality rates.…”

Section: Introductionmentioning

confidence: 99%

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Completion Pneumonectomy for Non-Small-Cell Lung Cancer: Does Induction Treatment Influence Postoperative Outcomes?

Galetta

Spaggiari

2022

Cancers

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Background: Completion pneumonectomy (CP) is associated with high morbidity and mortality. We reviewed our experience to evaluate whether induction treatment (IT) may affect postoperative outcomes and analyzed factors influencing long-term results. Methods: Between 1998 and 2020, 69 patients with lung cancer underwent CP (50 males, median age 63 years, right CP in 47 patients). A total of 23 patients (33.3%) received IT (chemotherapy in 15, chemoradiotherapy in 7, and radiation in 1). Surgery included 25 (36.2%) extended resections and five (7.2%) tracheal sleeve CP. Results: The 30-day mortality rate was 7.2% (5/69), and overall morbidity was 37.6%. Major complications occurred in five patients (7.2%): one cardiac dislocation, one diaphragmatic hernia, one transient ischemic attack (TIA), and two bronchopleural fistulas. Minor complications occurred in 21 cases (30.4%): pulmonary in 12, cardiac in 7, and neurological in 2. The median hospital stay was 8 days (range, 5–56 days). IT did not influence postoperative morbidity and mortality. Pathological staging included 19 (27.5%) stage I, 36 (52.2%) stage II, and 14 (20.3%) stage III. Overall 5-year survival was 51.7%. Factors influencing survival were IT (p = 0.01), extension of resection (p = 0.04), histology (p = 0.01), pathological stage (p = 0.03), and T and N factors (p = 0.2, respectively). Factors affecting survival in multivariate analysis included IT (p = 0.02) and histology (p = 0.03). Conclusions: In our experience, CP had a low mortality, acceptable morbidity, and good long-term survival, which justifies this surgical procedure. Postoperative complications were not influenced by IT. Long-term survival was adversely influenced by the absence of IT, the presence of extended resection, the presence of squamous cell carcinoma, and cancers at advanced stages.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Completion Pneumonectomy for Non-Small-Cell Lung Cancer: Does Induction Treatment Influence Postoperative Outcomes?

Galetta

Spaggiari

2022

Cancers

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“…The postoperative complication rate was 33%. Sezen et al [17] had a pneumonia rate of 18.8% in complementary pneumonectomy patients. In our study, 64.7% of pneumonectomy patients had complications.…”

Section: Discussionmentioning

confidence: 94%

“…In our study, the average total hospital cost was calculated as 3,917.5 TL for patients who did not have postoperative pneumonia and 8,211.7 TL for patients who developed pneumonia, which is a 2-fold increase. In a meta-analysis by Stone et al [20], one of the most extensive reviews on the subject, the highest costs relat-ed to nosocomial infection were due to catheter-associated bloodstream infections (38,703 USD), followed by pneumonia (17,677 USD). In the same study, the cost of surgical site infection was 15,646 USD, and the average cost attributable to infection was 13,973 USD.…”

Section: Discussionmentioning

confidence: 99%

Cost analysis and evaluation of risk factors for postoperative pneumonia after thoracic and cardiovascular surgery: a single-center study

Sezen¹,

Sezen²,

Yildirim³

et al. 2019

Curr Thorac Surg

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Background: Postoperative pneumonia increases costs associated with inpatient stay, treatment, laboratory testing, and imaging, thereby increasing total healthcare costs. The aim of this study was to determine risk factors in patients who develop pneumonia after thoracic and cardiovascular surgery, evaluate relationships between these risk factors and cost, and conduct a cost analysis of postoperative pneumonia. Materials and Methods: 111 patients who underwent major thoracic or cardiovascular surgery between June 2009 and March 2014 were evaluated retrospectively. Patients who developed postoperative pneumonia (p = 37) were compared with those who had no postoperative complications (p = 74). Results: 40 men and 71 women were included in the study. Mean length of hospital stay was 21 days for patients with pneumonia versus 10 days for patients without pneumonia (p < 0.001). Significant risk factors for postoperative pneumonia were Charlson Comorbidity Index > 2, steroid use, high ASA score, presence of nasogastric tube, peripheral/central venous catheterization, postoperative heart failure/acute kidney failure, total parenteral nutrition, late postoperative mobilization, and prolonged ventilation and intubation (p < 0.05). Postoperative pneumonia was associated with significantly higher mortality rate and total cost (p < 0.001 for both). The mean cost of treatment for patients with and without postoperative pneumonia was 8211.7 TL and 3917.5 TL, respectively (p < 0.001). There were statistically significant differences between the two groups in the costs of surgery, radiology, antibiotics, and cultures (p < 0.001 for all). Correlation analysis between risk factors and cost revealed that prolonged intubation, late mobilization, and lack of respiratory rehabilitation exercises were associated with higher costs (p < 0.05). Conclusions: Postoperative pneumonia significantly increases costs. Identifying and mitigating these factors will reduce both the incidence of infection and the associated costs. Because infection control measures help avoid infection and thereby infection-related costs, it is critically important to support infection control activities and prevent nosocomial infections.

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“…In previous studies this rate has been found to be 1-10% [4]. Non-surgical treatment is the primary modality for patients determined to have positive mediastinal lymph nodes (pN2) using CM [5,6]. Appropriate mediastinal staging reduces the number of patients undergoing unnecessary thoracotomy.…”

Section: Introductionmentioning

confidence: 99%

Does frozen section increase false negativity in cervical mediastinoscopy during mediastinal lymph node staging compared to paraffin section?

Erdoğu¹,

Metin²,

Sayar³

et al. 2020

Curr Thorac Surg

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Background: Cervical Mediastinoscopy (CM) is the most important invasive method in mediastinal lymph node staging. Lymph nodes dissected via CM can either be sent to frozen section (FS) for analysis allowing thoracotomy to be performed on the same session, or to paraffin section (PS) where thoracotomy is performed as a separate session (as a separate operation). This study compares the falsenegative ratio of mediastinoscopic FS and PS analysis. Materials and Methods: 454 patients with primary lung cancer who have undergone CM between January 2003 and December 2005 have been retrospectively analysed. This study evaluates whether FS analysis increases the false-negative rate of lymph node biopsies.Results: 160 cases from the PS group and 113 cases from the FS group were included in the study. The mean age of the patients was 56.4 years (range 28-77 years). There were 260 men and 13 women. In the PS group, mean thoracotomy time after CM was 9.9 days. False negativity of CM in the PS and the FS groups was found to be 9.2% and 8%, respectively. Conclusion:There was no statistically significant difference in terms of false negativity between FS and PS in mediastinal staging (p = 0.598).

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Long-term outcomes of completion pneumonectomy for non-small cell lung cancer

Cited by 5 publications

References 25 publications

Completion Pneumonectomy for Non-Small-Cell Lung Cancer: Does Induction Treatment Influence Postoperative Outcomes?

Completion Pneumonectomy for Non-Small-Cell Lung Cancer: Does Induction Treatment Influence Postoperative Outcomes?

Cost analysis and evaluation of risk factors for postoperative pneumonia after thoracic and cardiovascular surgery: a single-center study

Does frozen section increase false negativity in cervical mediastinoscopy during mediastinal lymph node staging compared to paraffin section?

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