Highly urgent versus elective pneumonectomy: Impact on short and long-term survival and survival hazards of patients with and without malignant disease

Background:

Highly urgent pneumonectomy may become necessary in rare oncological or benign indications in presence of cardiorespiratory impairment or of otherwise not treatable bleeding or sepsis. Whereas the negative impact of urgent pneumonectomy on perioperative survival has been described there are only few data about the long-term course following the intervention.

Material and Method:

We retrospectively evaluated 131 patients who had pneumonectomies since January 2003 (males: 101; females 30; mean age: 59,9 y; range: 20 – 87). In 117 of them malignancy, in 14 non-malignant, predominantly inflammatory disease was the indication for resection. 21 patients had highly urgent pneumonectomy on the day of admission, not allowing for previous functional assessment.

Fig. 1

Result:

Overall 5-year survival rate of elective patients was 31%, compared with 15% after highly urgent resection (p = 0.021). In multivariate Cox analysis, both emergency and tumour had a significant negative impact on overall survival. When age was taken additionally into account, only emergency and age proved to be significant predictors (since age and malignancy were closely correlated).

The flexible parametric model (Royston-Parma model) illustrates that the negative impact of emergency on survival shows an impressive peak immediately postoperatively, whereas the effect abates in later months and years.

Taking into account only non-tumour-related death, again emergeny has only an influence on early but not on later survival.

Conclusion:

Highly urgent pneumonectomy carries a considerable risk of perioperative death and thus reduces 5-year survival probability. If patients survive the first 2 years, however, the risk of non-tumour related death is the same as in elective patients.