Postoperative adverse events following surgical resection for non-small cell lung cancer (NSCLC) have been linked to poorer outcomes in prior reports, but their independent prognostic significance for long-term survival remains unclear. This retrospective, multicenter analysis aimed to determine whether postoperative complications independently affect long-term overall survival (OS) and recurrence-free survival (RFS) after lobectomy or segmentectomy for NSCLC.
The study reviewed 1,690 consecutive patients who underwent lobectomy or segmentectomy for NSCLC across 12 institutions from January 2017 through December 2018. Patients were categorized into two groups based on the presence or absence of postoperative complications: the complication group (n = 313) and the no-complication group (n = 1,377).
Overall survival and recurrence-free survival were assessed using Kaplan–Meier estimates. Multivariable Cox proportional hazards models with backward elimination were used to identify independent predictors of OS and RFS. The abstract reports hazard ratios (HRs) and p values for variables retained in the final OS and RFS models.
Postoperative complications occurred in 18.5% of the cohort. The most common complications reported were:
No additional breakdown of complication severity, timing, or management strategies was provided in the abstract.
Five-year survival estimates differed between groups. The reported 5-year OS was 82.1% in the complication group versus 88.5% in the no-complication group. Five-year RFS was 80.1% in the complication group versus 87.9% in the no-complication group. Both OS and RFS differences between groups were statistically significant (both p < 0.001) by unadjusted analysis.
In multivariable Cox regression, the following variables were independently associated with worse overall survival:
These findings indicate that, after adjustment for other covariates included in the model, experiencing a postoperative complication was independently associated with an approximately 66% higher hazard of death.
For recurrence-free survival, postoperative complications were not retained as an independent predictor in the multivariable model. Independent predictors of worse RFS included:
The abstract does not report HRs or p values for all of these RFS predictors individually in the text, beyond stating which variables were independent predictors.
This multicenter series of 1,690 patients undergoing NSCLC resection shows that postoperative complications are associated with lower unadjusted 5-year OS and RFS. After multivariable adjustment, complications remained an independent predictor of worse OS but not of RFS. The dissociation between effects on OS and RFS suggests that complications may worsen long-term survival through mechanisms other than increasing tumor recurrence—for example, by reducing physiological reserve, precipitating comorbidity‑related mortality, or affecting the ability to receive adjuvant therapy. The authors highlight the importance of optimized perioperative management to prevent complications and potentially improve long-term survival.
The abstract provides essential cohort-level results but omits several methodological details that affect interpretation. The following were not reported in the abstract and therefore cannot be inferred:
Because these details were not reported in the source abstract, they are not included here. Readers should consult the full text for complete methodology, variable definitions, and supplementary analyses.
In this retrospective multicenter cohort of NSCLC resections, postoperative complications occurred in 18.5% of patients and were independently associated with worse long-term overall survival (HR 1.657), but they did not independently predict recurrence-free survival after adjustment. The findings support efforts to minimize perioperative complications as part of strategies to improve long-term outcomes after lung cancer surgery.