Positive Postoperative Outcomes Associated Pulmonary Re-resection and Lung Volume Reduction Surgery

Two studies presented at the 65^th Annual Meeting & Exhibition of the Southern Thoracic Surgical Association focused on successful postoperative outcomes after performing lung surgeries.

One study found that, in patients with local recurrence or second primary lung cancer, multiple pulmonary resections (MPR) are superior to non-surgical management. Study author Ke-Neng Chen, MD, PhD, of the Peking University Cancer Hospital located in Beijing, China, shared the study’s results.

The retrospective review included patients who underwent synchronous or metachronous resections at two institutions between January 2000 and July 2015. Thirty-day postoperative mortality and complications per the Clavien-Dindo classification were the surgical safety endpoints. Five-year overall survival (OS) and five-year disease free survival (DFS) were the oncological efficacy endpoints in the synchronous MPR group, and for the metachronous MPR group, the endpoints were five-year OS after first surgery and five-year progression free survival (PFS) after second surgery. Researchers used propensity score matching (1:5) to compare survival outcomes between the synchronous MPR group and the solitary lung cancer resection (SLCR) group.

Of 1,887 consecutive primary lung cancer cases, there were 67 MPR cases in the database. Patients tended to be older (age ≥ 60 years, 72%). Most patients were male (63%). The MPR group had no severe complications or deaths within 30 days postoperatively. The synchronous MPR group had five-year OS and DFS rates of 84.5% and 64.4%, respectively. The authors observed no significant differences between five-year OS and DFS between the MPR group and the matched SLCR group. OS five years after the first surgery was 94.1%; five-year PFS after the second surgery was 41.2%, both of which were superior to the non-surgical treatment group (five-year OS, 50.7%; five-year PFS, 10.5%).

In their abstract, the study authors concluded that “oncological efficacy of MPR is superior to non-surgical approach in the management of the local recurrence or second primary lung cancer after initial curative resection, with comparable postoperative mortality and complications.”

In a second study, presented during a session called “Surgical Risk Functional Outcomes and Long Term Survival After Lung Volume Reduction Surgery: A 13 Year 119 Patient Single Center Experience,” Mark Ginsburg, MD, of Columbia University Medical Center in New York City, and colleagues evaluated the outcomes and survival rates associated with lung volume reduction surgery (LVRS).  The retrospective analysis aimed to address concerns pertaining to LVRS’s safety and resilience. Data were collected on 119 bilateral LVRS patients who underwent surgery at a single institution between January 2004 and January 2017.

“We looked at three areas: safety, efficacy, and survival,” Ginsburg said. “For safety, we looked at six-month surgical mortality, hospital morbidity, and discharge status. [For] efficacy, we looked at one-year functional results, and survival, we looked at one-, two-, and five-year Kaplan–Meier estimated survival.”

According to the study abstract, of the 119 patients, two had to undergo a unilateral procedure, leaving 117 bilateral patients (mean preoperative age 64 years), of which 82% were video-assisted thoracic surgery (VATS). Surgical six-month mortality was 0.84%, and mean length of hospital stay was eight days. Prolonged air leak presented in 65 (54.62%) of patients, pneumonia in seven (5.88%), and respiratory failure in four (3.36%). Three (2.67%) patients required reoperation. At one, two, and five years postoperatively, survival was 99%, 96%, and 80%, respectively. At baseline, FEV1 percent predicted was 26.26, RV percent of predicted was 210.57, DLCO2 percent of predicted was 29.12, and mean maximal workload was 38.81%. One year postoperatively, mean changes from baseline in 85 patients were as follows: FEV1 change in percent of value, 10.96; DLCO percent of predicted value, 5.02; maximal workload, 11.94.

“Surgical LVRS can be performed with a very low surgical risk of mortality and can be performed with very low risk of postoperative respiratory failure,” Ginsburg said. “Early one-year results show significant improvements in pulmonary function. Late outcomes demonstrate that still, more than half of our patients will die of respiratory failure. We think these results represent the standard against which alternative techniques of LVR should be measured.”