Current Thoracic Surgery

Background: Despite the widespread use of methods developed to preserve lung parenchyma as much as possible, pneumonectomy remains an essential surgical treatment option, particularly for lung cancers located centrally and/or invading bronchovascular structures. However, pneumonectomy has historically been associated with high morbidity and mortality. This study presents the complications, survival outcomes, and prognostic factors of patients who underwent pneumonectomy for lung cancer, drawing on 18 years of single-center experience.

Materials and Methods: Archived patient files from patients who underwent pneumonectomy at our center between 2006 and 2024 were retrospectively reviewed. Postoperative complications, 30- and 90-day mortality rates, overall survival, and recurrence-free survival were analyzed. Patients who underwent and did not undergo salvage surgery were analyzed as subgroups. Kaplan–Meier analysis was used for survival, and multivariate Cox regression analysis was used to examine prognostic factors.

Results: A total of 304 patients were included in the study. Postoperative 30- and 90-day mortality rates were consistent with the literature. Although there was no significant difference in overall survival between right and left pneumonectomy (p=0.504), the complication rate was higher in right pneumonectomies. Multivariate analysis revealed that age, adenocarcinoma histology, N2 positivity, receipt of adjuvant radiotherapy, and receipt of neoadjuvant therapy were independent predictors of poor prognosis.

Conclusions: Pneumonectomy remains an effective treatment option for selected patients with lung cancer. Advanced nodal disease, tumor size, and the presence of postoperative complications negatively impact survival. Effective use of a multidisciplinary tumor board, individualized treatment, and dedicated perioperative management are the most important criteria for improving long-term survival.