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J Thorac Cardiovasc Surg 2012;143:55-63
© 2012 The American Association for Thoracic Surgery

General Thoracic Surgery

An analysis, systematic review, and meta-analysis of the perioperative mortality after neoadjuvant therapy and pneumonectomy for non–small cell lung cancer

^a Section of Thoracic Surgery, School of Medicine, Yale University, New Haven, Conn
^b Department of Epidemiology and Public Health, School of Public Health, Yale University, New Haven, Conn

Received for publication August 19, 2010; revisions received July 30, 2011; accepted for publication September 13, 2011.

^_* Address for reprints: Anthony W. Kim, MD, Assistant Professor, Section of Thoracic Surgery, Yale University, School of Medicine, 330 Cedar St, BB 205, New Haven, CT 06520. (Email: anthony.kim{at}yale.edu).

Objective: Pneumonectomy after neoadjuvant therapy remains controversial.

Methods: A systematic PubMed search was performed for original articles from 1990 through 2010 describing pneumonectomy after neoadjuvant therapy. Specific data on 30-day and 90-day perioperative mortalities were abstracted from these articles. Meta-analysis compared 30-day mortality between right and left pneumonectomy with a fixed-effects model. Comparison between 30-day and 90-day mortalities was also performed.

Results: The search strategy yielded 27 studies. Overall, 30-day and 90-day perioperative mortalities were 7% and 12%, respectively. Among 15 studies providing side-specific 30-day mortality, cumulative mortalities were 11% and 5% for right and left pneumonectomies, respectively. In the meta-analysis that included 10 studies, 30-day mortality for right pneumonectomy remained greater than for left pneumonectomy (odds ratio, 1.97; 95% confidence interval, 1.11–3.49; P = .02). Among 6 studies providing side-specific 90-day mortality, cumulative mortalities were 20% and 9% for right and left pneumonectomies, respectively. In the meta-analysis that included 4 studies, 90-day mortality for right pneumonectomy was greater than for left pneumonectomy (odds ratio, 2.01; 95% confidence interval, 1.09–3.72; P = .03). Among 11 studies providing both 30-day and 90-day mortalities, mortality difference was 5% (95% confidence interval, 4%–7%, P < .0001). Pulmonary complications were the most common cause of 30-day and 90-day deaths.

Conclusions: Right pneumonectomy is associated with significantly higher 30-day and 90-day mortalities after neoadjuvant therapy than left pneumonectomy. Also, 90-day mortality for all pneumonectomies appears to be greater than expected, suggesting that the 30-day mortality figure may inadequately assess the perioperative mortality.