Annals of Surgical Oncology

, Volume 26, Issue 1, pp 230–237 | Cite as

Long-Term Prognostic Impact of Severe Postoperative Complications After Lung Cancer Surgery

  • Satoru Okada
  • Junichi Shimada
  • Daishiro Kato
  • Hiroaki Tsunezuka
  • Satoshi Teramukai
  • Masayoshi InoueEmail author
Thoracic Oncology



Postoperative complications are reportedly related to poor prognosis following lung cancer surgery; however, the difference in the prognostic impact according to immune-nutritional status is unknown.


In 411 patients with completely resected non-small cell lung cancer, the relationship between severe postoperative complications (SPCs; Clavien–Dindo grade III or higher) and survival was retrospectively analyzed, with special reference to preoperative immune-nutritional status based on the prognostic nutritional index (PNI), which was calculated using serum albumin level and total lymphocyte count.


A total of 52 (12.7%) patients had SPCs. The most common SPC was air leak (n = 39), atelectasis/sputum (n = 4), pneumonia (n = 2), pyothorax (n = 2), and bleeding (n = 2). The 5-year overall survival (OS) rates in patients with and without SPCs were 63.8% and 80.1%, respectively (p = 0.007). A multivariate Cox proportional hazard model revealed SPCs had a negative prognostic impact on patients with preserved immune-nutritional status (PNI ≥ 48.3; first to third quartile), but not on those with poor immune-nutritional status (PNI < 48.3; fourth quartile), with statistically significant interaction. Further analysis focused on 309 patients with preserved immune-nutritional status. The OS and relapse-free survival (RFS) rates were significantly worse in patients with SPCs than in those without (p < 0.001). After controlling for potential confounders, SPCs remained significantly associated with worse OS (adjusted hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.21–4.83; p = 0.015) and RFS (adjusted HR 2.02, 95% CI 1.10–3.53; p = 0.025).


Severe complications following lung cancer surgery could negatively impact prognosis, particularly in patients with preserved immune-nutritional status.



Satoru Okada, Junichi Shimada, Daishiro Kato, Hiroaki Tsunezuka, Satoshi Teramukai, and Masayoshi Inoue declare there are no conflicts of interest to disclose.

Supplementary material

10434_2018_7061_MOESM1_ESM.docx (29 kb)
Supplementary material 1 (DOCX 29 kb)
10434_2018_7061_MOESM2_ESM.tiff (15 mb)
Supplemental Figure 1 Overall and relapse-free survival in patients with completely resected non-small cell lung cancer was stratified according to preoperative PNI status and severe postoperative complications (A, B). PNI, prognostic nutritional index (TIFF 15397 kb)
10434_2018_7061_MOESM3_ESM.tiff (15 mb)
Supplemental Figure 2 Among patients with a preserved immune-nutritional status (PNI ≥ 48.3, n = 309), overall and relapse-free survival with completely resected non-small cell lung cancer was stratified according to the type of severe postoperative complication (A, B). PNI, prognostic nutritional index (TIFF 15397 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Satoru Okada
    • 1
  • Junichi Shimada
    • 1
  • Daishiro Kato
    • 1
  • Hiroaki Tsunezuka
    • 1
  • Satoshi Teramukai
    • 2
  • Masayoshi Inoue
    • 1
    Email author
  1. 1.Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Department of Biostatistics, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan

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