Long-term outcome after pneumonectomy at Siriraj Hospital.

ABSTRACT

Objective: The purpose of this study is to identify predictors of long term survival following pneumonectomy and compare New York Heart Association (NYHA) functional classification and ECOG performance status before and after surgery at Siriraj Hospital. Methods: All fifty three patients having a pneumonectomy between 1998 and 2009 were retrospectively studied. We compared each patient’s status before and after surgery. The parameters of survival were tested by univariate analysis, the Kaplan-Meier method, and differences in survival were determined by log-rank analysis. Results: There were 35 males (66%) and 18 females (34%) with a mean age (standard deviation) of 51±17 years (range 0.7-82 years). The majority of patients were lung cancer (77%) and destroyed lungs from infectious (12%) diseases. The mean follow-up time was 33 months, median 22 months, standard deviation 24 months, ranging between 0 and 131 months. Post-operative complication occurred in 11% of patients (bronchopleural fistula, bleeding, cardiac herniation and recurrent laryngeal nerve injury). Hospital mortality occurred in 7.5% (4 deaths). Late death occurred in 52.8% (28 deaths) including metastasis 30% (16 patients), pneumonia 19% (10 patients), and miscellaneous causes 3.7% (2 patients). Using univariate analysis, non lung cancer (P = 0.035) and the slow growing lung cancer (P = 0.007) were independent predictors of long term survival. The decrease in NYHA functional classification and ECOG performance status after surgery was not significant. Conclusion: Long-term survival after pneumonectomy for lung cancer occurred in 20% and non lung cancer in 60% of patients. Non lung cancer and the slow growing lung cancer were independent predictors of long term survival. Decreases in NYHA functional classification and ECOG performance status after pneumonectomy were not significant.