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Eur J Cardiothorac Surg 2001;20:476-480
© 2001 Elsevier Science NL

Pneumonectomy for non-small cell lung cancer: predictors of operative mortality and survival

Department of Cardiothoracic Surgery, City Hospital, Nottingham, NG5 1PB, UK

Received 2 October 2000; received in revised form 22 May 2001; accepted 25 May 2001.

Corresponding author. Tel.: +44-0115-969-1169; ext 46397
e-mail: david.beggs{at}pipex.dial.com

Objective: The purpose of this study was to identify predictors of operative mortality and survival following pneumonectomy for non-small cell lung cancer (NSCLC). Methods: All 206 patients having a pneumonectomy for NSCLC between 1991 and 1997 in our unit were prospectively studied. There were 162 males (79%) and 44 females (21%) with a mean age (± standard deviation) of 61±7.7 years (range 34–81 years). Squamous cell (75%) and adenocarcinoma (17.0%) were the predominant histological types. The possible impact of 29 parameters on operative mortality and survival was tested with univariate and multivariate analysis. The mean follow-up was 2.3±1.2 years, ranging between 0 and 6.8 years, and it was complete. Results: Operative mortality was 6.8% (14 deaths). On multiple logistic regression older age (P=0.04) and the development post-operatively of bronchopleural fistula (BPF) (P=0.01) were independent predictors of operative mortality. The overall, Kaplan–Meier, 1-, 3- and 5-year survival (± standard error from the mean), inclusive of operative mortality, was 68±3.3, 42±4.1 and 35±4.5%. On Cox proportional hazards regression adenocarcinoma (P=0.006), the development of BPF (P=0.003), older age (P=0.03) and higher pathological stage (P=0.02) were independent adverse predictors of survival. Conclusion: Pneumonectomy for NSCLC carries a considerable, but acceptable, operative mortality and provides an important survival benefit. This study suggests that older age and BPF are major determinants of an unfavourable in-hospital outcome; older age, BPF, adenocarcinoma cell type and higher pathological stage significantly reduce the probability of a long-term survival.

Key Words: Pneumonectomy • operative mortality • survival

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