Lung cancer surgery for patients on hemodialysis: A decade of experience at multicenter institutions

Abstract Background The clinical outcome of patients receiving hemodialysis (HD) has not yet been clarified in lung cancer surgery. The aims of this study were to assess the clinical features, outcomes and main cause of death following lung cancer surgery in HD patients and to evaluate the risk factors of postoperative complications. Methods We identified 39 patients receiving HD who underwent lung cancer surgery in 9 institutions under the Thoracic Surgery Study Group of Osaka University between 2007 and 2016. We retrospectively analyzed the surgical outcomes of these patients. Results Most patients were male and had a smoking habit. Diabetes mellitus was the most common cause of primary renal disease. Lobectomy with systemic lymph node dissection was performed in 16 patients, and an extended operation was performed in 6 patients. The most patients diagnosed with pStage IA (69.2%). The overall complication and mortality rates were 30.8% and 7.7%, respectively. Pneumonia was the most frequently observed complication. Extended operation was significantly associated with complications (p=0.04). The five-year overall survival rate was 57.9%, and the most common cause of death was a disease other than primary lung cancer that was related to HD. Conclusions Lung cancer surgery for HD patients provides favorable long-term outcomes despite higher postoperative mortality and morbidity rates. As an extended operation is significantly associated with postoperative complications, thoracic surgeons should carefully select the type of resection based on a balance between the therapeutic benefit and invasiveness in these patients.