Right-Sided Versus Left-Sided Pneumonectomy After Induction Therapy for Non-Small Cell Lung Cancer

Abstract

Background. A right-sided pneumonectomy after induction therapy for non-small cell lung cancer (NSCLC) has been shown to be associated with significant perioperative risk. We examined the effect of laterality on long-term survival after induction therapy and pneumonectomy using the National Cancer Data Base. Methods. Perioperative and long-term outcomes of patients who underwent pneumonectomy after induction chemotherapy, with or without radiotherapy, from 2004 to 2014 in the National Cancer Data Base were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Results. During the study period, 1,465 patients (right, 693 [47.3%]; left, 772 [52.7%]) met inclusion criteria. Right-sided pneumonectomy was associated with significantly higher 30-day (8.2% [57 of 693] vs 4.2% [32 of 772], p < 0.01) and 90-day mortality (13.6% [94 of 693] vs 7.9% [61 of 772], p < 0.01), and right-sided pneumonectomy was a predictor of higher 90-day mortality (odds ratio, 2.23; p < 0.01). However, overall 5-year survival between right and left pneumonectomy was not significantly different in unadjusted (37.6% [95% confidence interval {CI}, 0.34 to 0.42] vs 35% [95% CI, 0.32 to 0.39], log-rank p [ 0.94) or multivariable analysis (hazard ratio, 1.07; 95% CI, 0.92 to 1.25; p [ 0.40). A propensity score-matched analysis of 810 patients found no significant differences in 5-year survival between the right-sided versus left-sided groups (34.7% [95% CI, 0.30 to 0.40] vs 34.1%, [95% CI, 0.29 to 0.39], log-rank p [ 0.86). Conclusions. In this national analysis, right-sided pneumonectomy after induction therapy was associated with a significantly higher perioperative but not worse long-term mortality compared to a left-sided procedure.

Surgery for Mesothelioma After Radiation Therapy (SMART); A Single Institution Experience

“…Patients on this study experienced significant toxicity after EPP, which could have been exacerbated by decreased healing capacity due to neoadjuvant high-dose radiation. Compared to the 100% rate of grade 3+ post-operative toxicity observed on this study, previous reports of EPP for MPM without neoadjuvant radiation have reported 10-50% grade 3+ postoperative non-hematologic toxicity (4,12).…”

Clinicopathological Characteristics and Survival Outcomes for Pneumonectomy: a Population-Based Study

“…However, after matching, 1-, 3-, and 5-year OS rates were 75.4%, 50.7%, and 41.0% and there was no signi cant difference between sides (P>0.05). The results of Yang et al [16] were similar, but they did not nd signi cant difference in 5-year survival rate between left and right PN before or after matching.…”

A Nomogram to Predict Long-Term Survival Outcomes of Patients Who Undergo Pneumonectomy for Non-small Cell Lung Cancer With Stage I-IIIB

“…Riquet et al discovered that the overall survival after pneumonectomy among the 10-year survivors ( N = 250) could not be meaningfully distinguished by the laterality of tumor/surgery ( 14 ). Similarly, in 2019, Yang et al reported that right-sided or left-sided pneumonectomy after induction chemotherapy was not beneficial for long-term survival ( 23 ). Wang et al also analyzed the data of 100 cases with pneumonectomy and found that the right- or left-side resection didn't give a long-term survival benefit for those patients ( 24 ).…”