Safe pneumonectomy for locally advanced lung cancer after induction therapy

Purpose To assess the safety and long-term outcomes of pneumonectomy after IT (IT-Pn) versus upfront pneumonectomy without IT (U-Pn) for locally advanced non-small-cell lung cancer (NSCLC). Methods We reviewed the clinical records of 69 patients who underwent pneumonectomy as U-Pn ( n = 30) or IT-Pn ( n = 39) between 2000 and 2019 at our institution, Results U-Pn included patients with pathological N0 ( n = 13), N1 ( n = 11) and N2 ( n = 6). Among the patients treated with IT-Pn, 18 had pathological N0 (including 7 with complete responses), 5 had N1, 14 had N2, and 2 had N3. It was suggested that 22 cases could be down-staged after IT. The 5-year overall survival (OS) was 28.1% in the U-Pn group and 43.1% in the IT-Pn group ( p = 0.275), being 40.2% for IT-Pn with p-N2,3, but not reached for U-Pn with N2 ( p = 0.307). The 90-day mortality was 6.7% for the U-Pn group and 5.1% for the IT-Pn group ( p = 0.646). Major complications occurred in 25 patients (64.1%) treated with IT-Pn and 18 patients treated with U-Pn (60.0%; p = 0.602). Conclusions Pneumonectomy for NSCLC can be performed safely after IT with favorable results. For patients with N2 disease, induction therapy followed by surgery may warrant further study.