Recent results of postoperative mortality for surgical resections in lung cancer

Background. Changes in the postoperative mortality rates and causes of death for lung cancer surgery at the specialized hospital for cancer in Tokyo, Japan during the last 16 years were investigated. Methods. Data on 3,270 consecutive patients who underwent pulmonary resection for primary lung cancer between January 1987 and December 2002 at the National Cancer Center Hospital were retrospectively analyzed. The postoperative 30-day and in-hospital mortality rates and causes of death after pulmonary resection for lung cancer were investigated. Patients were divided into two period groups of almost equal number, the early (1,615 patients from 1987 to 1996) and the late (1,655 patients from 1997 to 2002) periods. Results. Fifty-eight operative and postoperative deaths occurred during the last 16 years. Thirty-day and in-hospital mortality were 0.6% (21/3,270) and 1.6% (58/ 3,270), respectively. During the last 6-year period, 30-day and in-hospital mortality were 0.5% (8/1,655) and 0.8% (21/1,655), respectively. The difference was significant between the 30-day/in-hospital mortality for pneumonectomy (3.1%/5.9%) and lobectomy (0.3%/1.3%) (p < 0.0001/p < 0.0001). The difference in mortality between lobectomy and segmentectomy or a lesser resection was not significant. The 58 deaths were caused by pneumonia/acute respiratory distress syndrome (ARDS) (36%, n = 21), bronchopleural fistula (BPF)/empyema (33%, n = 19), cerebrovascular accident (10%, n = 6), cardiac-related event (7%, n = 4), and others (14%, n = 8). The most frequent cause of death in the early period was BPF/ empyema (18/45, 40%), while that in the late period was pneumonia/ARDS (6/13, 46%). Among the pneumonia/ ARDS deaths in the late period (n = 6), 5 (83%) were due to acute deterioration of interstitial lung disease after lobectomy. Conclusions. Recent postoperative mortality rates (30-day, 0.5%; in-hospital, 0.8%) in the treatment of lung cancer are quite acceptable. Special care must be taken for the patient after pneumonectomy, as reported by others. Furthermore, even after lobectomy, proper management of the patient with acute deterioration of interstitial lung disease will be required to improve the future outcome. (C) 2004 by The Society of Thoracic Surgeons.