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Ann Thorac Surg 2008;85:1866-1873. doi:10.1016/j.athoracsur.2008.01.103
© 2008 The Society of Thoracic Surgeons
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Mohamed S. Boudaya
Jean-François Régnard
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Original Articles: General Thoracic

Pneumonectomy After Chemotherapy: Morbidity, Mortality, and Long-Term Outcome

Marco Alifano, MDa,b,*, Mohamed S. Boudaya, MDa, Maurizio Salvi, MDa, Jean-Yves Collet, MDa, Carmen Dinu, MDc,d, Sophie Camilleri-Broët, MDb,c,d, Jean-François Régnard, MDa,d

a Department of Thoracic Surgery, Hôtel Dieu Hospital, AP-HP, Paris, France
c Department of Pathology, Hôtel Dieu Hospital, AP-HP, Paris, France
b JE2492 Institut National de la Santé et de Recherche Médicale (INSERM), University Paris-Sud, Paris, France
d Faculty of Medicine Paris-Descartes, Paris, France

Accepted for publication January 17, 2008.

* Address correspondence to Dr Alifano, Unité de Chirurgie Thoracique, Hôtel Dieu, 1, Place du parvis Notre-Dame, Paris, Cedex 75181, France (Email: marcoalifano{at}yahoo.com).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: Results of pneumonectomy after chemotherapy are controversial, and the procedure is often considered as potentially dangerous.

Methods: Records of patients who underwent pneumonectomy after chemotherapy for non-small cell lung cancer in a single institution in a 6-year period were reviewed retrospectively.

Results: One hundred eighteen patients had pneumonectomy after chemotherapy. Indications for preoperative chemotherapy were N2 disease, 74; potentially resectable T4 disease, 17; doubtful resectability, 18; stage IV disease (nodule on another ipsilateral lobe), 4; and participation in a randomized trial on induction chemotherapy in initial stages, 5. Chemotherapy protocols were platinum-based. Imaging reevaluation showed complete, partial, minor response, and disease stability in 0, 24, 39, and 55 patients, respectively. Operative mortality was 5.9% (7 of 118), consisting of 4 of 54 after pneumonectomy, and 3 of 64 after left pneumonectomy. Bronchopleural fistula caused one death. No factor among those evaluated (sex, age, comorbidities, forced expiratory volume in 1 second, symptoms, side and location of tumor; indication for operation, number of cycles, and response to chemotherapy; extent of resection, TNM status, pathologic stage) predicted postoperative death. Median and overall 5-year survival was 22 months and 23.7%, respectively. At univariate analysis, pathologic stage, T status, and the occurrence of postoperative complications influenced 5-year survival. At multivariate analysis, T status (p = 0.0054), the occurrence of postoperative complications (p = 0.0015), and clinical response to induction chemotherapy (p = 0.028) were identified as independent predictors of 5-year survival.

Conclusions: Pneumonectomy after chemotherapy has acceptable mortality. Long-term results are encouraging.






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