According to an article recently published in the journal Chest, community-acquired pneumonia (pneumonia acquired outside of hospitals or extended-care facilities) is the leading cause of death among patients who undergo a pneumonectomy for non–small cell lung cancer. It is recommended that patients undergoing a pneumonectomy be monitored for symptoms of pneumonia and also take steps to prevent the illness.

Non–small cell lung cancer (NSCLC) is the most common type of lung cancer, comprising approximately 80% of all lung cancers. If the cancer has not spread outside of the lung, surgical removal of the cancer and parts of the affected lung is a common component of treatment. Depending upon the location and size of the cancer, different surgical procedures are performed.

A pneumonectomy is a surgical procedure that involves removal of the lung or the lung in addition to the lining of the heart and diaphragm. A pneumonectomy may be performed if the cancer is located closer to the middle of the lung or involves a significant portion of the main arteries or veins of the lung. A patient’s lung capacity is tested to determine if he/she is eligible for a pneumonectomy, as half of a patient’s breathing ability will be lost following the procedure.

A lobectomy, a less drastic procedure than a pneumonectomy, is the surgical removal of one lobe of a lung that contains cancer. This procedure is available to patients whose cancer is contained within one lobe of a lung.

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Researchers from Korea recently conducted a study to evaluate outcomes of patients with NSCLC who underwent a pneumonectomy or a lobectomy. This study included 94 patients who underwent a pneumonectomy and 147 patients who underwent a lobectomy between 1992 and 2000; these patients were long-term survivors following treatment. Patients who underwent a pneumonectomy tended to have more advanced and larger cancers.

  • Lung cancer relapses were uncommon in both groups of patients (2.1% for those who underwent pneumonectomy and 1.4% for those who underwent lobectomy).
  • At 10 years overall survival was 67.3% for patients who underwent pneumonectomy and 82.8% for those who underwent a lobectomy.
  • Death caused by lung cancer was nearly identical between the two groups of patients (6.5% for those who underwent a pneumonectomy and 4.9% for those who underwent a lobectomy).
  • The leading cause of death (nearly 15%) among patients who underwent a pneumonectomy was pneumonia.

The researchers concluded that pneumonectomy or lobectomy provide high cure rates for patients with early NSCLC. However, community-acquired pneumonia remains a significant issue among patients who undergo a pneumonectomy, causing the majority of deaths among these patients. The authors stated: “Continued surveillance should focus on prevention,early detection and aggressive management of intercurrent disease during follow-up care of these patients.”

Reference: Kim D, Lee J, Lee C, et al. Long-term survival following pneumonectomy for non–small cell lung cancer. Chest. 2007; 132:178-184.