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J Thorac Cardiovasc Surg 2006;132:519-523
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Does chemotherapy increase the risk of respiratory complications after pneumonectomy?

^a Thoracic Surgery Department, European Institute of Oncology, Milan, Italy
^b Statistics Department, European Institute of Oncology, Milan, Italy
^c University of Milan, School of Medicine, Milan, Italy.

Received for publication February 1, 2006; revisions received May 2, 2006; accepted for publication May 17, 2006.

^_* Address for reprints: Lorenzo Spaggiari, MD, Thoracic Surgery Department, European Institute of Oncology, Via Ripamonti 435, 20100 Milan, Italy (Email: lorenzo.spaggiari{at}ieo.it).

OBJECTIVE: The impact of induction chemotherapy on postoperative complications after pneumonectomy remains unclear. The aim of the study was to test the hypothesis that chemotherapy may increase the risk of postoperative respiratory complications.

METHODS: Data from 202 consecutive standard pneumonectomies performed for lung cancer were collected and analyzed. Postoperative and 90-day mortality, overall morbidity, and respiratory complication rates were evaluated in patients who had no induction treatment (group A, n = 103) as well as in those who received it (n = 99, group B). Preoperative chemotherapy was inserted as a variable together with 12 other variables (age, sex, smoking status, body mass index, previous cardiac event, American Society of Anesthesiologists score, preoperative forced expiratory volume in 1 second [percent], diffusion capacity for carbon monoxide adjusted for alveolar volume [percent], side of pneumonectomy, perfusion of the removed lung, operating time, and blood transfusion) into univariate and multivariate logistic regression.

RESULTS: No difference in terms of mortality was recorded between group A (4.9%) and group B (3%, P > .05). Respiratory complications were more frequent in group B than in group A (19 cases, 19.2%, vs 7 cases, 6.8%, P = .008). Univariate logistic regression has demonstrated that pulmonary complications were more frequent in patients over the age of 70 than in those aged 70 or less (25.7% vs 10.2, P = .02), in those with a lower diffusion capacity adjusted for alveolar volume (18.3% vs 5.95%, P = .06), and in patients who received preoperative chemotherapy (19.2% vs 6.8, P = .008). Logistic regression confirmed the role of age (odds ratio = 6.3), preoperative chemotherapy (odds ratio = 4.4), and diffusion capacity adjusted for alveolar volume (odds ratio = 0.33) as risk factors of respiratory complications.

CONCLUSIONS: Standard pneumonectomy is a safe procedure even after induction chemotherapy, with a mortality rate in the order of 5%, but this increases in patients over the age of 70 years. In the case of induction chemotherapy, the risk of respiratory complications is significantly increased, apparently not affecting the overall mortality rate.

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