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. 2019 May;11(5):2024-2033.
doi: 10.21037/jtd.2019.04.91.

Long-term impact of complications after lung resections in non-small cell lung cancer

Shuichi Shinohara  1 , Kenichi Kobayashi  1 , Chinatsu Kasahara  2 , Takamitsu Onitsuka  1 , Masaki Matsuo  2 , Makoto Nakagawa  1 , Masakazu Sugaya  1
Affiliations

Long-term impact of complications after lung resections in non-small cell lung cancer

Shuichi Shinohara et al. J Thorac Dis. 2019 May.

Abstract

Background: Postoperative complications after lung resection are common and fatal. The immediate effects of postoperative complications are related to poor prognosis; however, the long-term effects have not been assessed. Thus, this investigation aimed to clarify the long-term effects of postoperative complications among patients with resected non-small cell lung cancer (NSCLC).

Methods: This retrospective cohort study included 345 patients with resected NSCLC from a single institution. We used the Clavien-Dindo classification to classify postoperative complications. Postoperative complications were defined as complications with a Clavien-Dindo grade of ≥2. The Kaplan-Meier method was used to evaluate survival. Prognostic factors were analyzed using a Cox proportional hazard model.

Results: There were 110 patients with postoperative complications (31.9%). The 5-year overall survival (OS), recurrence-free survival (RFS), and cause-specific survival (CSS) rates were significantly lower in patients with complications than in those without complications [OS: 66.1%, 95% confidence interval (CI): 55.4-74.8% vs. 78.0%, 95% CI: 71.8-83.1%, P=0.001; RFS: 48.8%, 95% CI: 38.1-58.7% vs. 70.8%, 95% CI: 64.2-76.4%, P<0.001; CSS: 82.7%, 95% CI: 72.8-89.3% vs. 88.2%, 95% CI: 82.8-92.0%, P=0.005]. The 5-year OS was lower in the pulmonary complication group than in the other complication group (58.1%, 95% CI: 40.0-72.4% vs. 70.5%, 95% CI: 56.6-80.6%, P=0.033). Postoperative complications were indicated as a poor prognostic factor for OS (hazard ratio, 1.67; 95% CI: 1.11-2.53; P=0.002).

Conclusions: Postoperative complications were associated with unfavorable OS because of the worse prognosis of postoperative pulmonary complications.

Keywords: Non-small cell lung cancer (NSCLC); complication; long-term effect; prognosis; surgery.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves of patients with and without postoperative complications: (A) 5-year overall survival; (B) 5-year recurrence-free survival; and (C) 5-year cause-specific survival.
Figure 2
Figure 2
Kaplan-Meier survival curves of patients with pulmonary complications, those with other complications, and those without postoperative complications.
Figure 3
Figure 3
Subgroup analysis for the 5-year overall survival among patients with and without postoperative complications: (A) in pathological stage; (B) in smoking status.
See this image and copyright information in PMC

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