Long-term impact of complications after lung resections in non-small cell lung cancer

Shuichi Shinohara, Kenichi Kobayashi, Chinatsu Kasahara, Takamitsu Onitsuka, Masaki Matsuo, Makoto Nakagawa, Masakazu Sugaya


Background: Postoperative complications after lung resection are common and fatal. The immediate effects of postoperative complications are related to poor prognosis; however, the long-term effects have not been assessed. Thus, this investigation aimed to clarify the long-term effects of postoperative complications among patients with resected non-small cell lung cancer (NSCLC).
Methods: This retrospective cohort study included 345 patients with resected NSCLC from a single institution. We used the Clavien-Dindo classification to classify postoperative complications. Postoperative complications were defined as complications with a Clavien-Dindo grade of ≥2. The Kaplan-Meier method was used to evaluate survival. Prognostic factors were analyzed using a Cox proportional hazard model.
Results: There were 110 patients with postoperative complications (31.9%). The 5-year overall survival (OS), recurrence-free survival (RFS), and cause-specific survival (CSS) rates were significantly lower in patients with complications than in those without complications [OS: 66.1%, 95% confidence interval (CI): 55.4–74.8% vs. 78.0%, 95% CI: 71.8–83.1%, P=0.001; RFS: 48.8%, 95% CI: 38.1–58.7% vs. 70.8%, 95% CI: 64.2–76.4%, P<0.001; CSS: 82.7%, 95% CI: 72.8–89.3% vs. 88.2%, 95% CI: 82.8–92.0%, P=0.005]. The 5-year OS was lower in the pulmonary complication group than in the other complication group (58.1%, 95% CI: 40.0–72.4% vs. 70.5%, 95% CI: 56.6–80.6%, P=0.033). Postoperative complications were indicated as a poor prognostic factor for OS (hazard ratio, 1.67; 95% CI: 1.11–2.53; P=0.002).
Conclusions: Postoperative complications were associated with unfavorable OS because of the worse prognosis of postoperative pulmonary complications.