Advanced Age and high modified Glasgow Prognostic Score are associated with increased complications after pneumonectomy

Background:

Pneumonectomy is associated with increased morbidity and mortality compared to parenchyma sparing anatomic lung resections. The aim of this study was to identify risk factors in lung cancer patients undergoing curative intent pneumonectomy.

Material and method:

All newly diagnosed non-small cell lung cancer patients undergoing pneumonectomy in curative intent as the primary surgical procedure between 1/2013 and 12/2018 were retrospectively analyzed. We reviewed demographic, clinical, functional and surgical variables. Postoperative complications and 30- as well as 90- day mortality were analyzed to identify risk factors for postoperative morbidity and mortality.

Result:

103 lung cancer patients (67% male; mean age 62.3 ± 8.5) who underwent pneumonectomy with a curative intent have been identified. 62 patients (60%) received neoadjuvant treatment with chemotherapy (n = 20) chemoradiation (n = 42). Postoperative complications were registered in 35 (34%) patients (34%), with a major complication rate of 12%. Patients older than 65 years had a significantly higher risk for complications (p = 0.0039). There was a strong trend in patients with modified Glasgow Prognostic Score > 1 for higher postoperative complications (p = 0.0715). There was no increase in postoperative morbidity in patients who underwent neoadjuvant treatment. 30- and 90-day mortality was 2.9% and 2.9%, respectively.

Conclusion:

Pneumonectomy for lung cancer can be done with low postoperative morbidity and mortality. Elderly patients should receive a careful preoperative evaluation. Modified Glasgow Prognostic Score can be considered for risk stratification for this procedure.