Evaluation of the effects of postoperative pleural empyema on survival rates of patients after pneumonectomy due to non-small cell lung cancer

Introduction
Postpneumonectomy empyema (PPE) is a severe and often fatal complication of pneumonectomy, but some benefits of PPE were reported in patients who underwent either lobe or an entire lung resection due to lung cancer.

Aim
To compare the survival outcomes of patients with non-small-cell lung carcinoma (NSCLC), who developed PPE after pneumonectomy with uneventful recoveries available in our center’s database.

Material and methods
Outcomes of 928 pneumonectomies performed due to NSCLC between 1995 and 2009 were evaluated. The selection of the control group took into account the requirements for propensity score matching in terms of follow-up period, age, sex, tumor histopathology, TNM classification and the side of surgery.

Results
Thirty-two patients with a PPE syndrome and 96 patients without complications after pneumonectomy were included. The estimated 5- and 10-year survival rates were 71% and 59%, respectively. The average and median survival was almost two- and three-fold longer compared to the group with uneventful recoveries. A 2-fold lower cancer-related mortality rate and a 1.5-fold higher cancer-unrelated mortality rate were noted in the PPE group as opposed to the group without complications. Having recovered from PPE, the patients had their risk of death reduced by 2.5-fold and 3.5-fold due to all causes and cancer, respectively.

Conclusions
Pleural empyema in NSCLC patients who underwent pneumonectomy seems to improve the survival outcomes compared to patients with uneventful recoveries.