Lobectomy With Artery Reconstruction and Pneumonectomy for Non-Small Cell Lung Cancer: A Propensity Score Weighting Study.
Aged
Carcinoma, Non-Small-Cell Lung
/ blood supply
Disease-Free Survival
Female
Follow-Up Studies
Humans
Italy
/ epidemiology
Lung Neoplasms
/ blood supply
Male
Middle Aged
Morbidity
Neoplasm Staging
Pneumonectomy
/ methods
Postoperative Complications
/ epidemiology
Propensity Score
Pulmonary Artery
/ surgery
Plastic Surgery Procedures
/ methods
Reoperation
Retrospective Studies
Risk Factors
Survival Rate
/ trends
Treatment Outcome
Vascular Surgical Procedures
/ methods
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
20
07
2020
revised:
17
12
2020
accepted:
22
12
2020
pubmed:
13
1
2021
medline:
1
12
2021
entrez:
12
1
2021
Statut:
ppublish
Résumé
The treatment of non-small cell lung cancer is based, when suitable, on surgical resection. Pneumonectomy has been considered the standard surgical procedure for locally advanced lung cancers but it is associated with high mortality and morbidity rates. Reconstruction of the pulmonary artery, associated with parenchyma-sparing techniques, is meant to be an alternative to pneumonectomy. This retrospective single-center study is based on a detailed and comprehensive analysis of the clinical and oncologic data of patients treated between 2004 and 2016 through pneumonectomy or lobectomy with reconstruction of the pulmonary artery. A propensity score weighting approach, based on the preoperative characteristics of two groups of 124 patients each was performed. The subsequent statistical analysis evaluated long-term and short-term clinical outcomes together with risk factors analysis. The comparison between pneumonectomy and pulmonary artery reconstructions showed a higher 30-day (P = .02) and 90-day (P = .03) mortality rate in the pneumonectomy group, together with a higher incidence of major complications (P = .004). Long-term results have shown comparable outcomes, both in terms of 5-year disease-free survival (52.2% for pneumonectomy vs 46% for pulmonary artery reconstructions, P = .57) and overall 5-year survival (41.9% vs 35.6%, respectively; P = .57). Risk factors analysis showed that cancer-specific survival was related to lymph node status (P < .01) and absence of adjuvant therapy (P = .04). Lymph node status also influenced the risk of recurrence (P < .01). Lobectomy with reconstruction of the pulmonary artery is a valuable and oncologically safe alternative to pneumonectomy, with lower short-term mortality and morbidity, without affecting long-term oncologic results.
Sections du résumé
BACKGROUND
BACKGROUND
The treatment of non-small cell lung cancer is based, when suitable, on surgical resection. Pneumonectomy has been considered the standard surgical procedure for locally advanced lung cancers but it is associated with high mortality and morbidity rates. Reconstruction of the pulmonary artery, associated with parenchyma-sparing techniques, is meant to be an alternative to pneumonectomy.
METHODS
METHODS
This retrospective single-center study is based on a detailed and comprehensive analysis of the clinical and oncologic data of patients treated between 2004 and 2016 through pneumonectomy or lobectomy with reconstruction of the pulmonary artery. A propensity score weighting approach, based on the preoperative characteristics of two groups of 124 patients each was performed. The subsequent statistical analysis evaluated long-term and short-term clinical outcomes together with risk factors analysis.
RESULTS
RESULTS
The comparison between pneumonectomy and pulmonary artery reconstructions showed a higher 30-day (P = .02) and 90-day (P = .03) mortality rate in the pneumonectomy group, together with a higher incidence of major complications (P = .004). Long-term results have shown comparable outcomes, both in terms of 5-year disease-free survival (52.2% for pneumonectomy vs 46% for pulmonary artery reconstructions, P = .57) and overall 5-year survival (41.9% vs 35.6%, respectively; P = .57). Risk factors analysis showed that cancer-specific survival was related to lymph node status (P < .01) and absence of adjuvant therapy (P = .04). Lymph node status also influenced the risk of recurrence (P < .01).
CONCLUSIONS
CONCLUSIONS
Lobectomy with reconstruction of the pulmonary artery is a valuable and oncologically safe alternative to pneumonectomy, with lower short-term mortality and morbidity, without affecting long-term oncologic results.
Identifiants
pubmed: 33434540
pii: S0003-4975(21)00045-X
doi: 10.1016/j.athoracsur.2020.12.029
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1805-1813Informations de copyright
Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.