Evaluation of mortality in elective pneumonectomy in lung cancer after preoperative risk stratification

Hintergrund Parenchyma sparing resections such as sleeve resections are preferred over pneumonectomy for surgical treatment in patients with non-small lung cancer. Nevertheless some patients need to undergo this procedure to achieve radical-resection. Even though the resection therapy is curative and elective, pneumonectomy is still associated with a high postoperative morbidity and mortalitiy and extensive preoperative cardiopulmonal and functional evaluation is necessary. The aim of this study is to assess the 30-day mortality in patients undergoing elective curative pneumonectomy with special regard to preoperative risk scores such as Thoracic Revised cardiac Risk Index (ThRCRI).

Material und Methode All patients who underwent elective pneumonectomy for non small cell lung cancer in curative intention in our Department of Thoracic Surgery between 2008 and 2018 were included. In all cases video-assisted mediastinoscopic lymphadenectomy was performed. All patients with N2-status were excluded.

Analyses were performed retrospectively on the basis of prospective collection data regarding morbidity, mortality with emphasis on preoperative cardiopulmonary evaluation and assessment of the risk score.

Ergebnis We performed 158 elective pneumonectomies for non small cell lung cancer in curative intention between 2008 and 2018. 59 cases were right-sided (37%) and there was indication for bifurcation resection in 19 patients. The 30-day mortality was 10%. Respiratory failure, septic multi organ failure and right heart failure were the most frequent causes of death. 30 patients had three or more points in ThRCRI. There is a correlation between increased ThRCRI and mortality.

Schlussfolgerung Although pneumonectomy is an effective treatment option for non small cell lung cancer, a careful preoperative evaluation is necessary due to continuing high mortality, using established risk scores such as the ThRCRI.

Publication History

Article published online:
13 September 2022