Pneumonectomy for malignant disease: Factors affecting early morbidity and mortality

Objective: The purpose of this report is to analyze factors affecting morbidity and mortality after pneumonectomy for malignant disease. Methods: We retrospectively reviewed the cases of all patients who underwent pneumonectomy for malignancy at the Mayo Clinic. Between January 1, 1985, and September 30, 1998, 639 patients (469 men and 170 women) were identified. Median age was 64 years (range 20 to 86 years). Indication for pneumonectomy was primary lung cancer in 607 (95.0%) patients and metastatic disease in 32 (5.0%). Factors affecting morbidity and mortality were analyzed by univariate and multivariate analysis. Results: Cardiopulmonary complications occurred in 245 patients (38.3%; 95% confidence interval 34.6%-42.2%). Factors adversely affecting morbidity with univariate analysis included age (P <.0001), male sex (P = .04), associated respiratory (P = .02) or cardiovascular disease (P < .0001), cigarette smoking (P = .02), decreased vital capacity (P = .01), forced expiratory volume in I second (P < .0001), forced vital capacity (P = .002), diffusion capacity of the lung to carbon monoxide (P = .005), oxygen saturation (P < .05), arterial PO₂ (P = .007), preoperative radiation (P = .02), bronchial stump reinforcement (P = .007), crystalloid infusion (P = .01), and blood transfusion (P = .02). Factors adversely affecting morbidity with multivariate analysis included age (P = .0001) associated cardiovascular disease (P = .001), and bronchial stump reinforcement (P = .0005). There were 45 deaths (7.0%; 95% confidence intervals 5.2%-9.3%). Factors adversely affecting mortality with univariate analysis included associated cardiovascular (P <.0001) or hematologic disease (P <.005), lower preoperative serum hemoglobin level (P = .004), preoperative chemotherapy (P = .01), decreased diffusion capacity of lung to carbon monoxide (P = .002), right pneumonectomy (P = .0006), extended resection (P = .04), bronchial stump reinforcement (P = .007), and crystalloid infusion (P = .01). Factors affecting mortality with multivariate analysis included hematologic disease (P = .01), lower preoperative serum hemoglobin (P = .003), and completion pneumonectomy (P = .01). Conclusion: Multiple factors adversely affected morbidity and mortality after pneumonectomy for malignant disease. Appropriate selection and meticulous perioperative care are paramount to minimize risks in those patients who require pneumonectomy.