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  • Title: Pneumonectomy after chemoradiation therapy for non-small cell lung cancer: does "side" really matter?
    Author: Kim AW, Faber LP, Warren WH, Basu S, Wightman SC, Weber JA, Bonomi P, Liptay MJ.
    Journal: Ann Thorac Surg; 2009 Sep; 88(3):937-43; discussion 944. PubMed ID: 19699924.
    Abstract:
    BACKGROUND: The long-term benefits and risks of pneumonectomy after neoadjuvant chemoradiation therapy remain controversial. This study evaluated our experience with pneumonectomy for advanced non-small cell lung cancer (NSCLC) after concurrent chemoradiation therapy. METHODS: We reviewed medical records from patients undergoing concurrent chemoradiation therapy, followed by pneumonectomy (1983 to 2007). Clinical variables affecting Kaplan-Meier survival were analyzed. RESULTS: After chemoradiation therapy, 129 pneumonectomies (right, 65; left, 64) were performed. Postoperative pathologic stages were complete responders (CR), 21; I, 23; II, 19; III, 62; and IV, 4. The 90-day perioperative mortality was 20% (13 of 65) after right-sided pneumonectomy vs 9% (6 of 64) after left-sided pneumonectomy (p = 0.084). Complications occurred in 33% (43 of 129), including bronchopleural fistula in 12% (16 of 129) and acute respiratory distress syndrome in 2% (3 of 129). Overall 5-year survival was 33%. Survival was 32% for right-sided sections vs 34% for left-sided. CR patients had a 5-year survival of 48%. Survival of patients with postoperative N0, N1, and N2 nodes was 42%, 26%, and 28%, respectively. Multivariate analysis showed the development of major complications negatively affected 5-year survival for patients undergoing right-sided pneumonectomy (hazard ratio, 0.462; p = 0.0399). CONCLUSIONS: Pneumonectomy after concurrent chemoradiation therapy achieved long-term survival. When neoadjuvant therapy resulted in complete response or nodal downstaging, survival was improved. The risk of early perioperative death and complications was higher for right-sided procedures, but long-term survival did not differ between right- and left-sided pneumonectomy. Major complications negatively affected 5-year survival with right-sided pneumonectomies.
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