Morbidity and mortality after neoadjuvant therapy for lung cancer: The risks of right pneumonectomy

Background. The risks of complications in patients undergoing thoracotomy a fter neoadjuvant therapy for nonsmall cell lung cancer remain controversial . We reviewed our experience to define it further. Methods. All patients undergoing thoracotomy after induction chemotherapy f rom 1993 through 1999 were reviewed. Univariate and multivariate methods fo r logistic regression model were used to identify predictors of adverse eve nts. Results. Induction chemotherapy included mitomycin, vinblastine, and cispla tin (179 patients), carboplatin and paclitaxel (152 patients), and other co mbinations (139 patients). Eighty-five patients (18%) received preoperative radiation. Operations were pneumonectomy (97 patients), lobectomy (297 pat ients), lesser resection (18 patients), and exploration only (58 patients). Total mortality was 7 of 297 (2.4%) and 11 of 97 (11.3%) for all lobectomi es and pneumonectomies, respectively, but mortality was 11 of 46 (23.9%) fo r right pneumonectomy. Complications developed in 179 patients (38%). By mu ltiple regression analysis, right pneumonectomy (p = 0.02), blood loss (p = 0.01), and forced expiratory volume in one second (percent predicted) (p = 0.01) predicted complications. No factor emerged to explain this high righ t pneumonectomy mortality rate. Conclusions. Pulmonary resection after neoadjuvant therapy is associated wi th acceptable overall morbidity and mortality. However, right pneumonectomy is associated with a significantly increased risk and should be performed only in selected patients. (C) 2001 by The Society of Thoracic Surgeons.