Does pneumonectomy for lung cancer adversely influence long-term survival?

Objective: The increased operative mortality associated with pneumonectomy has stimulated the use of lung-sparing operations such as sleeve lobectomy, Whether pneumonectomy adversely affects long-term outcome after lung resec tion is unknown. Methods: We reviewed the cases of patients who underwent l obectomy/bilobectomy or pneumonectomy because of non-small cell lung cancer between January 1980 and June 1998, Survival curves were compared by the l og-rank test. Covariates were determined for operative mortality and surviv al using Logistic regression analysis and Cor; proportional hazards estimat ion, respectively, Results: There were 259 men and 183 women who underwent lobectomy/bilobectomy (340) or pneumonectomy (102). Operative mortality was 36 (8.1%) patients overall, 24 (7.0%) for lobectomy/bilobectomy and 12 (12 %) for pneumonectomy. Mean follow-up was 41 months (range 0-222 months), Me dian survival was worse for pneumonectomy (stage II: 17.9 vs 36.3 months, l og-rank P =.05; stage III: 11.7 vs 21.3 months, log-rank P =.07), However, important covariates for survival were age, primary tumor status, regional nodal status, and forced expiratory volume in 1 second. After adjusting for these covariates, survival did not differ significantly between the types of operations (hazard ratio for pneumonectomy 1.21; 95% CI 0.88-1.68), Conc lusions: We did not detect a significant long-term adverse influence of pne umonectomy on survival after adjusting for other prognostic factors, but ra ndomized clinical trials would be needed to definitively address this issue .