Right-sided vs Left-sided Pneumonectomy after Induction Therapy for Non-small-cell Lung Cancer. The Annals of thoracic surgery Yang, C. J., Shah, S., Lin, B. K., Vandusen, K., Chan, D. Y., Tan, W., Ranney, D., Cox, M., D'Amico, T. A., Berry, M. F. 2018


BACKGROUND: A right-sided pneumonectomy after induction therapy for non-small-cell lung cancer (NSCLC) has been shown to be associated with significant perioperative risk. We examined the impact of laterality on long-term survival after induction therapy and pneumonectomy using the National Cancer Data Base (NCDB).METHODS: Perioperative and long-term outcomes of patients who underwent pneumonectomy following induction chemotherapy with or without radiation from 2004-2014 in the NCDB were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis.RESULTS: During the study period, 1465 patients (right n=693 [47.3%], left n=772 [52.7%]) met inclusion criteria. Right-sided pneumonectomy was associated with significantly higher 30-day (8.2% [57/693] vs 4.2% [32/772], p< 0.01) and 90-day mortality (13.6% [94/693] vs 7.9% [61/772], p<0.01), and right-sided pneumonectomy was a predictor of higher 90-day mortality (OR 2.23, p<0.01). However, overall survival between right and left pneumonectomy was not significantly different in univariate (5-year survival 37.6% [95% CI: 0.34-0.42] vs 35% [95% CI: 0.32-0.39], log-rank p=0.94) or multivariable analysis (hazard ratio, 1.07 [95% CI: 0.92-1.25], p=0.40). In a propensity score-matched analysis of 810 patients, there were no significant differences in 5-year survival between the right- vs left-sided groups (34.7% [95% CI: 0.30-0.40] vs 34.1%, [95% CI: 0.29-0.39], log-rank p =0.86).CONCLUSIONS: In this national analysis, right-sided pneumonectomy after induction therapy was associated with a significantly higher perioperative but not worse long-term mortality compared to a left-sided procedure.

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