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Henning A. Gaissert
Cameron D. Wright
Dean M. Donahue
John C. Wain
Michael Lanuti
James S. Allan
Noah C. Choi
Douglas J. Mathisen
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J Thorac Cardiovasc Surg 2009;138:289-294
© 2009 The American Association for Thoracic Surgery

Point/Counterpoint

POINT: Operative risk of pneumonectomy—Influence of preoperative induction therapy

Henning A. Gaissert, MD*, Dong Yoon Keum, MD, Cameron D. Wright, MD, Marek Ancukiewicz, PhD, Eric Monroe, BS, Dean M. Donahue, MD, John C. Wain, MD, Michael Lanuti, MD, James S. Allan, MD, Noah C. Choi, MD, Douglas J. Mathisen, MD

Division of Thoracic Surgery and Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass

Received for publication May 12, 2008; revisions received October 1, 2008; accepted for publication November 15, 2008.

* Address for reprints: Henning A. Gaissert, MD, Massachusetts General Hospital, Blake 1570, Fruit Street, Boston, MA 02114. (Email: hgaissert{at}partners.org).

Background: Prior data indicate increased perioperative morbidity and mortality in patients receiving induction chemoradiotherapy before pneumonectomy for lung cancer.

Objective: We reviewed a consecutive series of pneumonectomies to determine the impact of induction therapy on operative mortality.

Results: Over a 15-year period, 183 patients underwent pneumonectomy for lung cancer. Forty-six received combined preoperative radiochemotherapy (25.2%), and 137 patients underwent resection only. Indications for induction therapy were stage IIB disease in 1, IIIA in 35, IIIB in 8, and IV in 2 patients. Patients receiving induction therapy were younger (mean age 58.4 vs 61.9 years; P = .033), had less heart disease (6.5 vs 26.3%; P = .0035), higher preoperative forced expiratory volume in 1 second (2.48 vs 2.13 L; P = .0018), a lower rate of endobronchial tumor (34.8 vs 67.2%; P = .0002), and underwent intrapericardial procedures more often (71.7 vs 43.1%; P = .0011). Hospital mortality was 4.3 % (2/46) after preoperative therapy and 6.6% (9/137) after resection only (P = .73); the difference in cardiopulmonary morbidity was not significant (51.1% vs 40.4%; P = .22). Induction did not predict hospital mortality after adjustment for a propensity score derived from nonoperative and operative variables correlated with neoadjuvant therapy.

Conclusions: A regimen of induction radiation and chemotherapy does not increase the operative mortality of pneumonectomy in carefully selected patients.

Abbreviations and Acronyms CT = computed tomography; FEV1 = forced expiratory volume in 1 second






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