Pneumonectomy: The Burden of Death After Discharge and Predictors of Surgical Mortality

Schneider, Laura; Farrokhyar, Forough; Schieman, Colin; Shargall, Yaron; D’Souza, Joanne; Camposilvan, Ivana; Hanna, Waël C.; Finley, Christian

doi:10.1016/j.athoracsur.2014.06.068

Cited by 27 publications

(21 citation statements)

References 28 publications

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“…The 30-day mortality (STS-GTSD +CMS data, Figure 4) is surprisingly similar to what has been reported in the NCDB for cIII-N2 patients (lobectomy 2.8%, pneumonectomy 7.8% and wedge 3%). 3 Roughly half of the operative mortalities occur between 30 and 90 days, which has been previously been shown for thoracic procedures 11,12 . Induction therapy does not appear increase 90-day mortality.…”

Section: Commentmentioning

confidence: 77%

Surgically Managed Clinical Stage IIIA–Clinical N2 Lung Cancer in The Society of Thoracic Surgeons Database

Boffa

Fernández

Kim

et al. 2017

The Annals of Thoracic Surgery

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Background The role of surgery in patients with clinical stage IIIA – N2 positive (cIIIA-N2) lung cancer is controversial, in part because of variability in short and long-term outcomes. The objective of this study was to characterize the management of cIIIA-N2 lung cancer in the Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD). Methods The STS-GTSD was queried for patients that underwent surgery for cIIIA-N2 lung cancer between 2002 and 2012. A subset of patients ≥65 years of age was linked to Medicare data. Results 3,319 surgically-managed, cIIIA-N2 patients were identified including 1,784 (54%) treated with upfront surgery (treatment naïve) and 1,535 (46%) with induction therapy. A PET scan was documented in 93% of patients, and 51% of patients were coded in STS-GTSD as having undergone invasive mediastinal staging. Nodal over-staging (cN2→pN0/N1) was observed in 43% of upfront surgery patients. Lobectomy was performed in 69% of patients and pneumonectomy in 11%. Operative mortality was similar between patients treated with upfront surgery (1.9%) and induction therapy 2.5%, p = .2583. The unadjusted Kaplan Meier estimate of 5-year survival of cIII-N2 patients treated with induction therapy then surgery was 35%. Conclusions STS surgeons achieve excellent short and long-term results treating predominantly lobectomy-amenable cIIIA-N2 lung cancer. However, prevalent over-staging and abstention from induction therapy suggest either “over-coding” of false positives on imaging, or variable compliance to current guidelines for cIIIA-N2 lung cancer. Efforts are needed to improve clinical stage determination and guideline compliance in the GTSD for this cohort.

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Section: Commentmentioning

confidence: 77%

Surgically Managed Clinical Stage IIIA–Clinical N2 Lung Cancer in The Society of Thoracic Surgeons Database

Boffa

Fernández

Kim

et al. 2017

The Annals of Thoracic Surgery

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“…In a series of 505 patients undergoing pneumonectomy from 2005 to 2011, more than half of the deaths occurred within the first 90 days after discharge from the hospital, 32 highlighting the importance of careful surveillance after hospital discharge. In the authors' practice, they provide rigorous outpatient care during the first 1 to 4 weeks following discharge from the hospital, including frequent office visits and telephone communications.…”

Section: Mortalitymentioning

confidence: 98%

“…32 The risk of a postoperative myocardial infarction is approximately 0.2% to 2.1% after standard pneumonectomy 2,24,37,47 and 1.5% after EPP. 39 Patients require a careful preoperative assessment to screen for undiagnosed or undertreated coronary artery disease.…”

Section: Myocardial Infarctionmentioning

confidence: 99%

“…Several contemporary series have reported mortalities to be 3% to 5.8% after standard pneumonectomy 3,4,21-24 and 5% to 8.5% after EPP. 22,[25][26][27][28][29] Several studies have identified various independent risk factors for 30-day hospital mortality, including American Society of Anesthesiologists classification, 30,31 congestive heart failure (CHF), 32 coronary artery disease, 31,33,34 prior acute myocardial infarction, 32 diabetes, 34 cerebrovascular disease, 32 chronic renal insufficiency, 32 lower FEV 1 , 29,30 malnutrition, 2 high preoperative C-reactive protein levels, 29 intraoperative blood loss (>4 units), 2 intravenous fluid volume, 35 right-sided pneumonectomy, 36 and low-volume centers. 34 Although increasing age has been identified by several studies as a risk factor for 30-day hospital mortality, 2,33,34,36 it is unclear from these studies whether associated comorbidities (which tend to occur at a greater frequency in older patients) are confounding this finding.…”

Section: Mortalitymentioning

confidence: 99%

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Management of Complications After Pneumonectomy

Groth

Burt

Sugarbaker

2015

Thoracic Surgery Clinics

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“…Evidence shows that these rates increase at 90 days after discharge of an additional 6% (72). In a recent study from the national cancer database on approximately 8,000 pneumonectomies operated on in four years the conditional 90 days mortality rate was 6% for a total mortality rate at 90 days after surgery of 14% (73).…”

Section: Pneumonectomymentioning

confidence: 99%

Preoperative functional workup for patients with advanced lung cancer

Brunelli

2016

J. Thorac. Dis.

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Locally advanced lung cancer remains a surgical indication in selected patients. This condition often demands larger resections. As a consequence preoperative functional workup is of paramount importance to stratify the risk and choose the most appropriate treatment. We reviewed the current evidence on functional evaluation with a special focus on specific aspects related to locally advanced lung cancer stages (i.e., risk after neoadjuvant treatment, pneumonectomy). Evidence is discussed to provide information that could assist clinicians in their preoperative workup of these challenging patients.

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Pneumonectomy: The Burden of Death After Discharge and Predictors of Surgical Mortality

Cited by 27 publications

References 28 publications

Surgically Managed Clinical Stage IIIA–Clinical N2 Lung Cancer in The Society of Thoracic Surgeons Database

Surgically Managed Clinical Stage IIIA–Clinical N2 Lung Cancer in The Society of Thoracic Surgeons Database

Management of Complications After Pneumonectomy

Preoperative functional workup for patients with advanced lung cancer

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