Is pneumonectomy after induction chemotherapy for non-small cell lung cancer a reasonable procedure? A multicenter retrospective study of 228 cases.

Introduction: Pneumonectomy (PN) after induction chemotherapy (CT) for non-small cell lung cancer is controversial because high-mortality rates are still reported.

Methods: This multicenter retrospective study included all patients treated by induction CT then PN between January 1993 and April 2006 in four General and Thoracic Surgery Departments. Postoperative mortality and morbidity and long-term outcomes were studied.

Results: The study considered 228 patients. Doublets with cisplatin and vinorelbine or gemcitabine were used in 66% of cases. pTNM stages (World Health Organization, 1997) were 0 (2%), I (16%), II (25%), IIIA (29%), IIIB (16%), and IV (12%). The postoperative morbidity rate was 37% (84 of 228 patients). The independent risk factors identified for postoperative morbidity were chronic obstructive pulmonary disease, more than four cycles of induction CT or an association of cisplatin, and an old cytotoxic molecule, extended PN, and extended anesthesia time. Postoperative mortality rates were 5.3% at 30 days (12 of 228 patients) and 9.2% at 90 days (21 of 228 patients). The independent risk factors identified for operative mortality were chronic obstructive pulmonary disease, manual suture of the stump, and pTNM stage higher than IIIA. The 90-day mortality rates were 10.3% (12 of 117) for right PN and 8.2% (9 of 111) for left PN (p = 0.65). The overall survival (OS) rates were 68% at 1 year, 39% at 3 years, and 32% at 5 years.

Conclusions: Induction CT was not found to compromise short- or long-term outcomes after PN in non-small cell lung cancer. The right or left PN performed by experienced surgeons after induction CT seems to be a reasonable procedure in case of tumor local extension.