• Gregory D Jones, Raul Caso, Kay See Tan, Joseph Dycoco, Prasad S Adusumilli, Manjit S Bains, Robert J Downey, James Huang, James M Isbell, Daniela Molena, Bernard J Park, Gaetano Rocco, Valerie W Rusch, Smita Sihag, David R Jones, and Matthew J Bott.
• Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
• Ann. Surg. 2022 Apr 1; 275 (4): 793799793-799.

ObjectiveWe sought to quantify and characterize long-term consequences of pneumonectomy, with particular attention to nononcologic mortality.Summary Of Background DataPneumonectomy is associated with profound changes in cardiopulmonary physiology. Studies of long-term outcomes after pneumonectomy typically report generalized measures, such as disease-free and overall survival.MethodsPatients undergoing lobectomy or pneumonectomy for lung cancer at our institution from 2000 to 2018 were reviewed. Propensity-score matching was performed for 12 clinicopathologic factors. Ninety-day complications and deaths were compared. Five-year cumulative incidence of oncologic and nononcologic mortality were compared using competing risks approaches.ResultsFrom 3339 lobectomy and 355 pneumonectomy patients identified, we derived 318 matched pairs. At 90 days, rates of overall complications were similar (46% for pneumonectomy vs 43% for lobectomy; P = 0.40), but rates of major complications (21% vs 13%; P = 0.005) and deaths (6.9% vs 1.9%; P = 0.002) were higher the pneumonectomy cohort. The cumulative incidence of oncologic mortality was not significantly different between cohorts (P = 0.9584). However, the cumulative incidence of nononcologic mortality was substantially higher in the pneumonectomy cohort for both date of surgery and 1-year landmark analyses (P < 0.0001 and P = 0.0002, respectively). Forty-five pneumonectomy patients (18%) died of nononcologic causes 1-5 years after surgery; pneumonia (n = 21) and myocardial infarction (n = 10) were the most common causes. In pneumonectomy patients, preexisting cardiac comorbidity and low diffusion capacity of the lungs for carbon monoxide were predictive of nononcologic mortality.ConclusionsCompared to lobectomy, excess mortality after pneumonectomy extends beyond 1 year and is driven primarily by nononcologic causes. Pneumonectomy patients require lifelong monitoring and may benefit from expeditious assessment and intervention at the initial signs of illness.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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