Ninety-day complications after lung lobectomy and bilobectomy: A cohort single-center retrospective study

Background. Lobectomy is one of the most performed procedures in thoracic surgery. The fact that domestic literature does not provide an analysis of long-term outcomes after lobectomy and bilobectomy prompted us to conduct this study and identify factors that have a reliably negative effect. Objective. To evaluate postoperative complications occurring within 90 days after lobectomy and bilobectomy performed for malignant neoplasms and to identify their risk factors. Methods. The cohort single-center retrospective study included 277 patients who underwent open and thoracoscopic lung resection (lobectomy and bilobectomy) from January 2021 to December 2023 at the Surgical Oncology Department No. 3 of the Republican Clinical Oncology Center (Ministry of Health of the Chuvash Republic). The patients were divided into two groups: the first group (n = 232) comprised patients without complications, and the second group (n = 45) consisted of patients with complications. The overall postoperative case fatality rate within 90 days after the performed surgical procedure was evaluated. Hospital readmissions and all outpatient visits were analyzed. All clinical complications within 90 days after lobectomy and bilobectomy were recorded, and their risk factors were identified. The obtained results were statistically analyzed using Statistica 10 (StatSoft, USA). Results. The study analyzed 90-day postoperative complications in patients after lung resection (lobectomy and bilobectomy). The rate of complications amounted to 16.25% (45/277). Within 90 days after the procedure, the overall case fatality rate amounted to 6.5% (18/277), with the inpatient and posthospital case fatality rates reaching 1.81% (5/277) and 4.69% (13/277), respectively. In the present study, the hospital readmission rate was 7.22% (20/277), which is lower than in other known similar studies conducted abroad, where the reported values ranged from 9.3 to 24.8%. In the second group, patients predominantly had an ECOG2 performance status (Eastern Cooperative Oncology Group). The main risk factor for complications was the extent of surgery. Thoracotomy with rib resection and marginal pulmonary artery resection increased the rate of complications. Conclusion. The conducted study comprehensively analyzed the rate and composition of postoperative complications within 90 days after lobectomy and bilobectomy performed for malignant neoplasms. The key risk factors for complications were identified, which include marginal pulmonary artery resection and thoracotomy with rib resection, as well as ECOG status and the presence of complications of the primary disease (e.g., atelectasis and pneumonia). No effect of conventional parameters such as age, sex, and smoking was found on the rate of complications. The absence of significant differences in complication rates between thoracoscopic and open resection requires further study on larger samples of participants. The study results highlight the need for prospective studies aimed at a more in-depth analysis of postoperative complications and their risk factors

1. Agaoglu Sanli B, Turk Y, Sirzai EY, Yazgan S, Ucvet A. Long-term results of middle lobectomy patients operated for non-small cell lung cancer. Indian J Thorac Cardiovasc Surg. 2025;41(4):404–410. https://doi.org/10.1007/s12055-024-01886-4

2. Cai H, Huang C, Wu H, Wu Y, Huang Z, Su S, Li C. Comparing the Efficacy of Video-Assisted Thoracoscopic Surgery and Open Thoracotomy in Sleeve Lobectomy for the Treatment of Central-Type Non-small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Altern Ther Health Med. 2024;30(6):76–81.

3. Agostini P, Lugg ST, Adams K, Vartsaba N, Kalkat MS, Rajesh PB, Steyn RS, Naidu B, Rushton A, Bishay E. Postoperative pulmonary complications and rehabilitation requirements following lobectomy: a propensity score matched study of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy. Interact Cardio vasc Thorac Surg. 2017;24(6):931–937. https://doi.org/10.1093/icvts/ivx002

4. Forster C, Doucet V, Perentes JY, Abdelnour-Berchtold E, Zellweger M, Faouzi M, Bouchaab H, Peters S, Marcucci C, Krueger T, Rosner L, Gonzalez M. Impact of an enhanced recovery after surgery pathway on thoracoscopic lobectomy outcomes in non-small cell lung cancer patients: a propensity score-matched study. Transl Lung Cancer Res. 2021;10(1):93–103. https://doi.org/10.21037/tlcr-20-891

5. Huang L, Frandsen MN, Kehlet H, Petersen RH. Early and late readmissions after enhanced recovery thoracoscopic lobectomy. Eur J Cardiothorac Surg. 2022;62(3):ezac385. https://doi.org/10.1093/ejcts/ezac385

6. Brunelli A, Dinesh P, Woodcock-Shaw J, Littlechild D, Pompili C. Ninety-Day Mortality After Video-Assisted Thoracoscopic Lobectomy: Incidence and Risk Factors. Ann Thorac Surg. 2017;104(3):1020– 1026. https://doi.org/10.1016/j.athoracsur.2017.02.083

7. Bagrov VA, Ryabov AB, Pikin OV, Kolbanov KI, Glushko VA, Vursol DA, Amiraliev AM, Rudakov RV, Barmin VV. Complications after thoracoscopic lobectomy in patients with malignant lung tumors. P.A. Herzen Journal of Oncology. 2018;7(4):26–33 (In Russ.). https://doi.org/10.17116/onkolog20187426

8. Esakov YuS, Efteev LA, Banova ZhI, Gaforov DA, Suryakhina YaI, Tukvadze ZG, Galkin VN. Enhanced recovery in thoracic surgery. Pirogov Russian Journal of Surgery. 2021;10:68–74 (In Russ.). https://doi.org/10.17116/hirurgia202110168

9. Das-Neves-Pereira JC, Bagan P, Coimbra-Israel AP, Grimaillof-Junior A, Cesar-Lopez G, Milanez-de-Campos JR, Riquet M, Biscegli-Jatene F. Fast-track rehabilitation for lung cancer lobectomy: a five-year experience. Eur J Cardiothorac Surg. 2009;36(2):383–391. https://doi.org/10.1016/j.ejcts.2009.02.020

10. D’Andrilli A, Rendina EA. Enhanced recovery after surgery (ERAS) and fast-track in video-assisted thoracic surgery (VATS) lobectomy: preoperative optimisation and care-plans. J Vis Surg. 2018;4:4. https://doi.org/10.21037/jovs.2017.12.17

11. Damhuis RA, Wijnhoven BP, Plaisier PW, Kirkels WJ, Kranse R, van Lanschot JJ. Comparison of 30-day, 90-day and in-hospital postoperative mortality for eight different cancer types. Br J Surg. 2012;99(8):1149–1154. https://doi.org/10.1002/bjs.8813

12. Luan TMB, Bang HT, Vuong NL, Dung LT, Tin NT, Tien TQ, Nam NH. Long-term outcomes of video-assisted lobectomy in non-small cell lung cancer. Asian Cardiovasc Thorac Ann. 2021;29(4):318–326. https://doi.org/10.1177/0218492321997380

13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

14. Pezzi CM, Mallin K, Mendez AS, Greer Gay E, Putnam JB Jr. Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality. J Thorac Cardiovasc Surg. 2014;148(5):2269–2277. https://doi.org/10.1016/j.jtcvs.2014.07.077

15. Taylor M, Grant SW, West D, Shackcloth M, Woolley S, Naidu B, Shah R. Ninety-Day Mortality: Redefining the Perioperative Period After Lung Resection. Clin Lung Cancer. 2021;22(4):e642–e645. https://doi.org/10.1016/j.cllc.2020.12.011

16. Hashimoto S, Tominaga T, Nonaka T, Noda K, Kiya S, Shiraishi T, Oishi K, Takamura Y, Yamazaki S, Araki M, Sumida Y, Miyazaki T, Kamohara R, Morino S, Matsumoto K, Nakamura A, Nagayasu T. Longterm outcomes and early recurrence after resection for metachronous pulmonary metastases from colorectal cancer. Langenbecks Arch Surg. 2023;409(1):24. https://doi.org/10.1007/s00423-023-03209-4

17. Green A, Hauge J, Iachina M, Jakobsen E. The mortality after surgery in primary lung cancer: results from the Danish Lung Cancer Registry. Eur J Cardiothorac Surg. 2016;49(2):589–594. https://doi.org/10.1093/ejcts/ezv107

18. Piwkowski C, Gabryel P, Campisi A, Orłowski TM, Zieliński M, Rzyman W, Kowalewski J, Czyżewski D, Grochowski Z, Wójcik J, Sowińska A, Roszak M; Polish National Lung Cancer Registry. Ninety-Day Mortality of Thoracoscopic vs Open Lobectomy: A Large Multicenter Cohort Study. Ann Thorac Surg. 2023;115(3):693–699. https://doi.org/10.1016/j.athoracsur.2022.07.050

19. Tomizawa K, Usami N, Fukumoto K, Sakakura N, Fukui T, Ito S, Hatooka S, Kuwano H, Mitsudomi T, Sakao Y. Risk assessment of perioperative mortality after pulmonary resection in patients with primary lung cancer: the 30- or 90-day mortality. Gen Thorac Cardiovasc Surg. 2014;62(5):308–313. https://doi.org/10.1007/s11748-014-0375-0

20. Powell HA, Tata LJ, Baldwin DR, Stanley RA, Khakwani A, Hubbard RB. Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit. Thorax. 2013;68(9):826–834. https://doi.org/10.1136/thoraxjnl-2012-203123

21. Stiles BM, Poon A, Giambrone GP, Gaber-Baylis LK, Wu X, Lee PC, Port JL, Paul S, Bhat AU, Zabih R, Altorki NK, Fleischut PM. Incidence and Factors Associated With Hospital Readmission After Pulmonary Lobectomy. Ann Thorac Surg. 2016;101(2):434–442. https://doi.org/10.1016/j.athoracsur.2015.10.001

22. Heiden BT, Keller M, Meyers BF, Puri V, Olsen MA, Kozower BD. Assessment of short readmissions following elective pulmonary lobectomy. Am J Surg. 2023;225(1):220–225. https://doi.org/10.1016/j.amjsurg.2022.07.031

23. Vlăsceanu S, Mahler B, Marghescu AȘ, Bădărău IA, Moldovan H, Gheorghiță D, Costache M, Savu C. The Nine-Year Survival of Patients Operated for Non-Small-Cell Lung Carcinoma in a Tertiary Centre: The Impact of the Tumour Stage and Other Patient-Related Parameters. Medicina (Kaunas). 2024;60(3):415. https://doi.org/10.3390/medicina60030415

24. Rjabov AB, Pikin OV, Glushko VA, Kolbanov KI, Bagrov VA, Aleksandrov OA, Barmin VV, Martynova DE, Vorobyeva EYu, Larionov DA. Surgical treatment of lung cancer in patients over 75 years old. Pirogov Russian Journal of Surgery. 2022;12:20–30 (In Russ.). https://doi.org/10.17116/hirurgia202212120

25. Benker M, Citak N, Neuer T, Opitz I, Inci I. Impact of preoperative comorbidities on postoperative complication rate and outcome in surgically resected non-small cell lung cancer patients. Gen Thorac Cardiovasc Surg. 2022;70(3):248–256. https://doi.org/10.1007/s11748-021-01710-5

26. Leduc C, Antoni D, Charloux A, Falcoz PE, Quoix E. Comorbidities in the management of patients with lung cancer. Eur Respir J. 2017;49(3):1601721. https://doi.org/10.1183/13993003.01721-2016

27. Yang Y, Cheng C, He B, Du X, Liu J, Xia H, Wang P, Wu M, Wu H, Liu Q. Cigarette smoking, by accelerating the cell cycle, promotes the progression of non-small cell lung cancer through an HIF-1α-METTL3-m6A/CDK2AP2 axis. J Hazard Mater. 2023;455:131556. https://doi.org/10.1016/j.jhazmat.2023.131556

28. Bluman LG, Mosca L, Newman N, Simon DG. Preoperative smoking habits and postoperative pulmonary complications. Chest. 1998;113(4):883–889. https://doi.org/10.1378/chest.113.4.883

29. Tang A, Ahmad U, Toth AJ, Bourdakos N, Raja S, Raymond DP, Blackstone EH, Murthy SC. Non-small cell lung cancer in neverand ever-smokers: Is it the same disease? J Thorac Cardiovasc Surg. 2021;161(6):1903–1917.e9. https://doi.org/10.1016/j.jtcvs.2020.03.175

30. Burt JR, Qaqish N, Stoddard G, Jridi A, Anderson PS, Woods L, Newman A, Carter MR, Ellessy R, Chamberlin J, Kabakus I. Non-small cell lung cancer in ever-smokers vs never-smokers. BMC Med. 2025;23(1):3. https://doi.org/10.1186/s12916-024-03844-8

31. Jeon JH, Kang CH, Kim HS, Seong YW, Park IK, Kim YT, Kim JH. Video-assisted thoracoscopic lobectomy in non-small-cell lung cancer patients with chronic obstructive pulmonary disease is associated with lower pulmonary complications than open lobectomy: a propensity score-matched analysis. Eur J Cardiothorac Surg. 2014;45(4):640–645. https://doi.org/10.1093/ejcts/ezt460

32. Ye B, Wang M. Video-assisted Thoracoscopic Surgery versus Thoracotomy for Non-Small Cell Lung Cancer: A Meta-Analysis. Comb Chem High Throughput Screen. 2019;22(3):187–193. https://doi.org/10.2174/1386207322666190415103030

33. Geissen NM, Medairos R, Davila E, Basu S, Warren WH, Chmielewski GW, Liptay MJ, Arndt AT, Seder CW. Number of Ribs Resected is Associated with Respiratory Complications Following Lobectomy with en bloc Chest Wall Resection. Lung. 2016;194(4):619–624. https://doi.org/10.1007/s00408-016-9882-3