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Current Thoracic Surgery 2025 , Vol 10 , Issue 1
Clinical evaluation of intrapericardial pneumonectomies applied in non-small cell lung cancer
Bahar Ağaoğlu Şanlı1,Volkan Karaçam2,Fatma Mutlu2,Berfin Kızıldağ Aktaş2,Dündar Özalp Karabay3,Aydın Şanlı2
1Department of Thoracic Surgery, Izmir City Hospital, İzmir, Turkey
2Department of Thoracic Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
3Department of Cardiovascular Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey DOI : 10.26663/cts.2025.001 Viewed : 26 - Downloaded : 15 Background: In non-small cell lung cancer (NSCLC), pulmonary artery, pulmonary vein, pericardium, or atrium involvement is not considered as an inoperability criterion, although it negatively affects the disease prognosis. In these patients accepted as local disease, intrapericardial pneumonectomy can be performed to leave a safe surgical margin. In this study, patients diagnosed with NSCLC who underwent intrapericardial pneumonectomy were subjected to clinical evaluation.

Materials and Methods: We retrospectively evaluated NSCLC patients who were diagnosed as T3- T4 and N0-N1 with preoperative invasive staging, who responded to neoadjuvant treatment for T4N2 disease, or who were considered persistent N2 and underwent intrapericardial pneumonectomy for intrapericardial pulmonary artery (PA) and pulmonary vein (PV) invasion.

Results: Thirteen patients underwent intrapericardial left pneumonectomy and 7 patients underwent intrapericardial right pneumonectomy. The median overall survival (OS) value of the patients included in the study was found to be 22.3 months, 95% CI (Confidence Interval) (5.6-39.0). The 1-month postoperative survival rate was 90%, the 6-month survival rate was 88%, the 1-year survival rate was 84%, and the 3-year survival rate was 35%. The assessment of the 5-year survival rate was conducted among 13 cases who successfully completed the 5-year follow-up period, revealing a median OS of 35,0 months and a 5-year survival rate of 23%. Patients who did not receive pre-op neoadjuvant therapy, patients who underwent right pneumonectomy and patients with squamous histopathology had a lower median OS and higher HRs for mortality.

Conclusions: In NSCLC patients who underwent intrapericardial pneumonectomy, right pneumonectomy, lymph node involvement, lymphovascular invasion, and lack of neoadjuvant treatment were evaluated as poor prognostic factors. Keywords : intrapericardial pneumonectomy, non-small cell lung cancer, thoracic surgery