Pneumonectomy – permanent injury or still effective method of treatment? Early and long-term results and quality of life after pneumonectomy due to non- small cell lung cancer

Abstract

Introduction Despite the constant decrease of performed pneumonectomies (PN) in recent years, it is still necessary for 15–20% of patients with non-small cell lung cancer (NSCLC) to undergo total lung resection due to the local progression of the disease. Aim To assess the frequency and type of postoperative complications, quality of life, and the early and long-term results after PN performed due to NSCLC. Material and methods In the total group of 1160 patients, operated on in 2008–2011 due to NSCLC, 192 of them underwent PN (16.6%). The quality of life was analysed using EORTC-QLQ-C30 questionnaire. Results Perioperative mortality after PN was 4%. Five-year survival reached 45%. The factors that significantly affected the 5-year survival in multivariate analysis were: pTNM stage, pN stage, intrapericardial resection, and additional extrapulmonary structures resection. The mean Global Quality of Life was 50.8. The Symptom Scale ranged from 7 to 54.3, the Functional Scale from 58.2 to 76.3 and the rate for NSCLC symptoms ranged from 2.2 to 48.1. Conclusions Pneumonectomies in patients with NSCLC is associated with higher risk of postoperative complications but it does not significantly increase the perioperative mortality. Long-term results in this group of patients are encouraging. According to the questionnaire, the quality of life is favourable. Low intensity of typical NSCLC symptoms was observed. The appropriate qualification for right-sided PN and exclusion of metastasis in N2 nodes are crucial.

Analyzing the impact of minimally invasive surgical approaches on post-operative outcomes of pneumonectomy and sleeve lobectomy patients

“…When comparing our PN outcomes in current literature we had similar results. In a study of 1,160 patients, Skrzypczak et al experienced 30-day mortality of 4% and a five-year survival of 45% ( 28 ). They also experienced 56.7% morbidity, as defined by the patients experiencing at least one complication ( 28 ).…”

“…In a study of 1,160 patients, Skrzypczak et al experienced 30-day mortality of 4% and a five-year survival of 45% ( 28 ). They also experienced 56.7% morbidity, as defined by the patients experiencing at least one complication ( 28 ). Gu et al analyzed 406 patients and experiences a 30-day mortality of 3.2% and saw a five-year survival of 32.5% ( 29 ).…”

Drug Regimen for Patients after a Pneumonectomy

“…Despite the benefits brought by pneumonectomy, postoperative complications are still problematic. Atrial fibrillation (AF) is the most common complication [23,128], whereas bronchopleural fistula (BPF) and postpneumonectomy syndrome (PPS) are relatively rare but can be life-threatening [6][7][8]129]. There are several pharmaceutical drug regimens to treat postoperative AF.…”

Study of the predictors for radiation pneumonitis in patient with non-small cell lung cancer received radiotherapy after pneumonectomy

“…Previous studies have tried to correlate the incidence of RP following lung cancer surgery with several clinical and dosimetric variables [9,10].However, most of them were conducted on the effect of RP after pulmonary lobectomy and rarely covered pneumonectomy. Although pneumonectomy is a high-risk procedure associated with greater morbidity and mortality, it is still necessary for a tumor located near the center of the lung invading the large vascular or main bronchus when lobectomy cannot achieve safe margin [11][12][13]. Compared to receive radiotherapy after lobectomy, patients underwent pneumonectomy suffered a signi cant decrease in overall survival [14,15].…”