Background: In order to assess the short term risks of pneumonectomy for lung cancer in
contemporary practice a one year prospective observational study of pneumonectomy outcome
was made. Current UK practice for pneumonectomy was observed to note patient and treatment
factors associated with major complications.
Methods: A multicentre, prospective, observational cohort study was performed. All 35 UK
thoracic surgical centres were invited to submit data to the study. All adult patients undergoing
pneumonectomy for lung cancer between 1 January and 31 December 2005 were included. Patients
undergoing pleuropneumonectomy, extended pneumonectomy, completion pneumonectomy
following previous lobectomy and pneumonectomy for benign disease, were excluded from the
The main outcome measure was suffering a major complication. Major complications were defined
as: death within 30 days of surgery; treated cardiac arrhythmia or hypotension; unplanned intensive
care admission; further surgery or inotrope usage.
Results: 312 pneumonectomies from 28 participating centres were entered. The major
complication incidence was: 30-day mortality 5.4%; treated cardiac arrhythmia 19.9%; unplanned
intensive care unit admission 9.3%; further surgery 4.8%; inotrope usage 3.5%. Age, American
Society of Anesthesiologists physical status ≥ P3, pre-operative diffusing capacity for carbon
monoxide (DLCO) and epidural analgesia were collectively the strongest risk factors for major
complications. Major complications prolonged median hospital stay by 2 days.
Conclusion: The 30 day mortality rate was less than 8%, in agreement with the British Thoracic
Society guidelines. Pneumonectomy was associated with a high rate of major complications. Age,
ASA physical status, DLCO and epidural analgesia appeared collectively most associated with major complications