Number of Ribs Resected is Associated with Respiratory Complications Following Lobectomy with en bloc Chest Wall Resection Nicole M. Geissen 1 • Robert Medairos 1 • Edgar Davila 1 • Sanjib Basu 2 • William H. Warren 1 • Gary W. Chmielewski 1 • Michael J. Liptay 1 • Andrew T. Arndt 1 • Christopher W. Seder 1 Received: 9 February 2016 / Accepted: 11 April 2016 Ó Springer Science+Business Media New York 2016 Abstract Purpose Pulmonary lobectomy with en bloc chest wall resection is a common strategy for treating lung cancers invading the chest wall. We hypothesized a direct rela- tionship exists between number of ribs resected and post- operative respiratory complications. Methods An institutional database was queried for patients with non-small cell lung cancer that underwent lobectomy with en bloc chest wall resection between 2003 and 2014. Propensity matching was used to identify a cohort of patients who underwent lobectomy via thoraco- tomy without chest wall resection. Patients were propensity matched on age, gender, smoking history, FEV1, and DLCO. The relationship between number of ribs resected and postoperative respiratory complications (bron- choscopy, re-intubation, pneumonia, or tracheostomy) was examined. Results Sixty-eight patients (34 chest wall resections; 34 without chest wall resection) were divided into 3 cohorts: cohort A = 0 ribs resected (n = 34), cohort B = 1–3 ribs resected (n = 24), and cohort C = 4–6 ribs resected (n = 10). Patient demographics were similar between cohorts. The 90-day mortality rate was 2.9 % (2/68) and did not vary between cohorts. On multivariate analysis, having 1–3 ribs resected (OR 19.29, 95 % CI (1.33, 280.72); p = 0.03), 4–6 ribs resected [OR 26.66, (1.48, 481.86); p = 0.03), and a lower DLCO (OR 0.91, (0.84, 0.99); p = 0.02) were associated with postoperative res- piratory complications. Conclusions In patients undergoing lobectomy with en bloc chest wall resection for non-small cell lung cancer, the number of ribs resected is directly associated with inci- dence of postoperative respiratory complications. Keywords Lung Á Cancer Á Outcomes Á Chest Wall Background Lung cancer is the most common cause of cancer-related death in the United States and worldwide [1, 2]. Between 5 and 8 % of patients undergoing resection for non-small cell lung cancer (NSCLC) have direct involvement of the chest wall [3]. The five-year survival of patients with lung cancer invading the chest wall has been reported to be between 15 and 40 %, depending on nodal status [3, 4]. Anatomic pulmonary resection with en bloc chest wall resection is a common strategy for treating lung cancers that invade the chest wall [4, 5]. The goal of surgery is to resect the primary tumor with negative surgical margins. While this treatment strategy may improve survival in some cases, chest wall resection is associated with impaired lung function and significant morbidity [6]. Studies have demonstrated that after en bloc chest wall resection, postoperative quality of life is markedly dimin- ished. Preoperative FEV 1 (forced expiratory volume in one second), postoperative FEV 1 , and the extent of chest wall resection have been reported to predict quality of life and survival following lung resection with en bloc chest wall resection [7]. & Christopher W. Seder christopher_w_seder@rush.edu 1 Departments of Cardiovascular and Thoracic Surgery, Rush University Medical Center, 1725 W. Harrison Street, Chicago, IL 60612, USA 2 Departments of Preventative Medicine, Rush University Medical Center, Chicago, IL 60612, USA 123 Lung DOI 10.1007/s00408-016-9882-3