Objective: A right-sided pneumonectomy after induction therapy for non-small cell lung cancer (NSCLC) has been shown to be associated with significant perioperative risk. We examined the impact of laterality on long-term survival using the National Cancer Data Base (NCDB).
Methods: Perioperative and long-term outcomes of patients who underwent pneumonectomy following induction chemotherapy ± radiation from 2003-2011 in the NCDB were evaluated using Kaplan-Meier method, multivariable logistic regression analysis and multivariable Cox proportional hazards modeling.
Results: During the study period, 1,652 patients met inclusion criteria, of whom 740 (45%) underwent right-sided pneumonectomies. Right-sided patients were more likely to have had adenocarcinoma, clinical N2 disease and lower co-morbidity scores. The 30-day mortality rate was significantly higher for right sided procedures in univariable (11% [84/740] vs 4% [39/912], p<0.001) and multivariable (OR 9.1 [1.8-50.0], p<0.01) analysis. However, 5-year overall survival between right (31.7% [26.4-37.1%]) and left pneumonectomy (34.9% [29.4-40.5%] were not significantly different after a median follow up of 30.2 months. Right-side procedure also did not impact overall survival in multivariable analysis (hazard ratio, 1.41 [95% CI: 0.87-2.27], p=0.16).
Conclusion: In this population analysis, right-sided pneumonectomy after induction therapy was associated with a significantly higher perioperative but not worse long-term mortality compared to a left-sided procedure. These findings can be used in the risk/benefit analysis when considering patients for pneumonectomy following induction therapy.