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The Major Morbidity and Mortality Criteria in Pneumonectomies

Year 2013, Volume: 5 Issue: 3, 17 - 23, 01.12.2013

Abstract

Aim: We aimed to investigate the major morbidity and mortalities, especially bronchopleural fistulas in patients who underwent pneumonectomy. Methods: Between October 2005 and January 2011, 178 patients were retrospectively analyzed who underwent pneumonectomy. The patient characteristics of age, sex, lateralization, induction therapy, co-morbid diseases and pathologic stages were set. Statistical analyses were performed with logistic regression analyses to compare the parameters with mortality and morbidity. Results: The mean age was 57.3. Major morbidity occurred in 49 27.5% patients. The morbidities included 11 bronchopleural fistula 6.1% , 11 6.1% aritmia, 5 2.8% respiratory insuffiency, 5 2.8% pneumonia, and 8 4.6% other morbidities. Discussion: Pneumonectomy itself has high morbidity and mortality rates, which also has a negative impact on the quality of life among patients with lung resections. Therefore, it should be noted that high risk patients must be carefully investigated and close monitorization must be applied.

References

  • Licker M, Spiliopoulos A, Frey JG, Robert J, Höhn L, de Perrot M, Tschopp JM. Risk factors for ear- ly mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest. 2002 121:1890-1897.
  • Shields TW Lung Cancer: Surgical Treatment of Non-Small Cell Lung Cancer. General Thoracic Surgery, Baltimore, Philadelphia, London; Willi- am & Wilkins, ed: TW Shields; sixth edition, Chap- ter 99.
  • Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B et al. Pulmonary complica- tions following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000 Nov;118(5):1263-1270.
  • Algar FJ, Alvareza Aranda, JL Salvatierra A, Baa- monde Prediction of early bronchopleureal fistu- la pneumonectomy: a multivariate analysis. Ann Thorac Surg 2001,72:1662-1667.
  • Harpole DH, Liptay MJ, DeCamp MM Jr, Ment- zer SJ, Swanson SJ, Sugarbaker DJ. Prospecti- ve analysis of pneumonectomy: risk factors for major morbidity and cardiac dysrhythmias. Ann Thorac Surg. 1996 Mar;61(3):977-82.
  • Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H. What are the risk factors for arrhytmias after thoracic operations? A retrospective multivaria- te analysis of 267 consecutive thoracic operati- ons. J Thorac Cardiovasc 1993; 106: 104-111.
  • Von Knorring J, Lapantalo M, Lindgren C, Lind- fors O. Cardiac arrhytmias and myocardial ische- mia after thoracotomy for lung cancer. Ann Tho- rac Surg 1992; 53: 642-647.
  • Ramesh L. Patel, FRCS(Ed), Edward R. Townsend, FRCS, S.William Fountain, FRC. Elective pneu- monectomy: Factors associated with morbidity and operative mortality. Ann ThoracSurg 1992; 54:84-88.
  • Shapiro M, Swanson SJ, Wright CD, Chin C, Sheng S, Wisnivesky J, Weiser TS. Predictors of major morbidity and mortality after pneumonectomy utilizing the Society for Thoracic Surgeons Ge- ner- Thoracic Surgery Database. Ann Thorac Surg. 2010;90:927-934; discussion 934-935.
  • Terauchi Y, Kitaoka H, Tanioka K, Kubo T, Imamu- ra S, Baba Y, Kawada Y, Noguchi T, Okawa M, Ya- masaki N, Yabe T, Doi Y. Inferior acute myocardial infarction due to acute cardiac herniation after right pneumonectomy. Cardiovasc Interv Ther. 2012;27:110-3. Epub 2012 Feb 28.
  • Darling GE, Abdurahman A, Yi QL, Johnston M, Waddell TK, Pierre A, Keshavjee S, Ginsberg R.Risk of a right pneumonectomy: role of bronchopleu- ral fistula. Ann Thorac Surg.2005; 79: 433-437.
  • atel RL, Townsend ER, Fountain SW. Elective pneumonectomy: Factors associated with mor- bidity and operative mortality. Ann Thorac Surg 1992; 54: 84.
  • Asamura H, Naruke T, Tsuchiya R, Goya T. Bron- chopleural fistulas associated with lung cancer operations. Univariate and multivariate analy- sis of risk factors, management and outcome. J Thorac Cardiovasc Surg 1992; 104: 1456-1464.
  • Purek L, Licker M, Frey JG, Spiliopoulos A, Ts- chopp JM. Bronchopleural fistula: a serious complication after thoracic surgery. Rev Med Suisse. [Article in French] 2009 13;5:1056-1060.
  • Licker M, Spiliopoulos A, Frey JG, Robert J, Höhn L, de Perrot M, Tschopp JM.Risk factors for early mortality and major complications followingp- neumonectomy for non-small cell carcinoma of the lung. Chest. 2002 ; 121:1890-1897.
  • López Pujol J, Alvarez Kindelán A, Algar Algar J, Cerezo Madueño F, López Rivero L, Salvatierra Velázquez A. Perioperative morbimortality in pneumonectomy. Analysis of risk factors.Arch Bronconeumol. 2000;36:251-256.
  • Peter H. Hollaus, MD, Franz Lax, MD, PhD, Ba- sem B. El-Nashef, MD, Herwig H. Hauck, MD,Pa- olo Lucciarini, MD, Nestor S. Pridun, MD Natural History of Bronchopleural Fistula After Pneu- monectomy: A Review of 96 Cases. Ann Thorac Surg 1997;63:1391-1396.
  • JR Hankins, JE Miller, S Attar, JR Satterfield and JS McLaughlin. Bronchopleural fistula. Thirte- en-year experience with 77 cases. J Thorac Car- diovasc Surg. 1978;76:755-762.
  • Sirbu H, Busch T, Aleksic I, Schreiner W, Oster O, Dalichau H. Bronchopleural fistula in the sur- gery of non-small cell lung cancer: incidence, risk factors, and management. Ann Thorac Car- diovasc Surg. 2001;7: 330-336.
  • Alexiou C, Beggs D, Onyeaka P, Kotidis K, Ghosh S, Beggs L, et al. Pneumonectomy for stage I (T1N0 and T2N0) nonsmall cell lung cancer has potent, adverse impact on survival. Thorac Surg. 2003 Oct;76(4):1023-8.
  • Gökhan Yuncu, Ahmet Üçvet, Güven Olgaç, Serpil Sevinç, Hatice Alıc KHDAK Nedeniyle Cer- rahi Uygulanmış Olgularımız: 5 Yıllık Deneyim Türk Toraks Dergisi. 2004; 5: 13-19. experience. Surg Today. 2012;42(6):542-546.

Pnömonektomilerde Majör Mortalite ve Morbidite Kriterleri

Year 2013, Volume: 5 Issue: 3, 17 - 23, 01.12.2013

Abstract

Amaç: Çalışmamızın amacı pnömonektomi yapılan hastaların mortalitesini ve morbiditesini incelemek, komplikasyonları özellikle bronkoplevral fistülleri BPF ayrıntılı olarak irdelemektir. Metod: Ekim 2005-Ocak 2011 tarihleri arasında pnömonektomi yapılan 178 hasta retrospektif olarak değerlendirildi. Yaş, cinsiyet, operasyon tarafı, indüksiyon terapisi, eşlik eden sistemik hastalık ve kanser evreleri belirlendi. İstatistik olarak lojistik regresyon analizi uygulandı. Hastaların morbidite ve mortalite değerlerinin bu parametrelerle ilişkisi değerlendirildi. Bulgular: Ortalama yaş 57,3 olarak belirlendi. 40 hastada %22,4 majör morbidite gelişti; 11 hastada %6,1 bronkoplevral fistül BPF , 11 hastada %6.1 postoperatif aritmi, 5 hastada akut respiratuvar yetmezlik %2.8 , 5 hastada pnömoni %2.8 ve 8 hastada %4.6 diğer morbiditeler gelişti. Neoadjuvan tedavi alan 11 hastadan 5 kişide %44.9 bronkoplevral fistül görüldü p=0.01 . Ondört hastada %8.1 mortalite görüldü. Bu 14 hastanın 5‘i %35.7 geç dönem bronkoplevral fistül ve fistül komplikasyonları nedeniyle kaybedildi. Bronkoplevral fistül riski sağ pnömonektomi sonrası 7/77,%9 , sol pnömonektomiye oranla 4/101,%3.9 daha yüksekti. Morbiditeyi artıran faktörler ileri yaş p=0.01 ve sağ pnömonektomi p=0.03 idi. Mortaliteyi anlamlı düzeyde etkileyen faktör ise ileri yaş p=0.049 idi. Sonuç: Pnömonektomi akciğer rezeksiyonları içinde hastaların yaşam kalitesini en kötü etkileyen, mortalite ve morbidite oranı en yüksek operasyon şeklidir. Bu sebeple operasyon sonrası daha çok risk taşıyan grupların değerlendirilebilmesi ve dikkatli olunması önemlidir. Operasyon sonrası gelişebilecek komplikasyonlara karşı erken tanı için hastalar iyi takip edilmelidir.

References

  • Licker M, Spiliopoulos A, Frey JG, Robert J, Höhn L, de Perrot M, Tschopp JM. Risk factors for ear- ly mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest. 2002 121:1890-1897.
  • Shields TW Lung Cancer: Surgical Treatment of Non-Small Cell Lung Cancer. General Thoracic Surgery, Baltimore, Philadelphia, London; Willi- am & Wilkins, ed: TW Shields; sixth edition, Chap- ter 99.
  • Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B et al. Pulmonary complica- tions following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000 Nov;118(5):1263-1270.
  • Algar FJ, Alvareza Aranda, JL Salvatierra A, Baa- monde Prediction of early bronchopleureal fistu- la pneumonectomy: a multivariate analysis. Ann Thorac Surg 2001,72:1662-1667.
  • Harpole DH, Liptay MJ, DeCamp MM Jr, Ment- zer SJ, Swanson SJ, Sugarbaker DJ. Prospecti- ve analysis of pneumonectomy: risk factors for major morbidity and cardiac dysrhythmias. Ann Thorac Surg. 1996 Mar;61(3):977-82.
  • Asamura H, Naruke T, Tsuchiya R, Goya T, Kondo H. What are the risk factors for arrhytmias after thoracic operations? A retrospective multivaria- te analysis of 267 consecutive thoracic operati- ons. J Thorac Cardiovasc 1993; 106: 104-111.
  • Von Knorring J, Lapantalo M, Lindgren C, Lind- fors O. Cardiac arrhytmias and myocardial ische- mia after thoracotomy for lung cancer. Ann Tho- rac Surg 1992; 53: 642-647.
  • Ramesh L. Patel, FRCS(Ed), Edward R. Townsend, FRCS, S.William Fountain, FRC. Elective pneu- monectomy: Factors associated with morbidity and operative mortality. Ann ThoracSurg 1992; 54:84-88.
  • Shapiro M, Swanson SJ, Wright CD, Chin C, Sheng S, Wisnivesky J, Weiser TS. Predictors of major morbidity and mortality after pneumonectomy utilizing the Society for Thoracic Surgeons Ge- ner- Thoracic Surgery Database. Ann Thorac Surg. 2010;90:927-934; discussion 934-935.
  • Terauchi Y, Kitaoka H, Tanioka K, Kubo T, Imamu- ra S, Baba Y, Kawada Y, Noguchi T, Okawa M, Ya- masaki N, Yabe T, Doi Y. Inferior acute myocardial infarction due to acute cardiac herniation after right pneumonectomy. Cardiovasc Interv Ther. 2012;27:110-3. Epub 2012 Feb 28.
  • Darling GE, Abdurahman A, Yi QL, Johnston M, Waddell TK, Pierre A, Keshavjee S, Ginsberg R.Risk of a right pneumonectomy: role of bronchopleu- ral fistula. Ann Thorac Surg.2005; 79: 433-437.
  • atel RL, Townsend ER, Fountain SW. Elective pneumonectomy: Factors associated with mor- bidity and operative mortality. Ann Thorac Surg 1992; 54: 84.
  • Asamura H, Naruke T, Tsuchiya R, Goya T. Bron- chopleural fistulas associated with lung cancer operations. Univariate and multivariate analy- sis of risk factors, management and outcome. J Thorac Cardiovasc Surg 1992; 104: 1456-1464.
  • Purek L, Licker M, Frey JG, Spiliopoulos A, Ts- chopp JM. Bronchopleural fistula: a serious complication after thoracic surgery. Rev Med Suisse. [Article in French] 2009 13;5:1056-1060.
  • Licker M, Spiliopoulos A, Frey JG, Robert J, Höhn L, de Perrot M, Tschopp JM.Risk factors for early mortality and major complications followingp- neumonectomy for non-small cell carcinoma of the lung. Chest. 2002 ; 121:1890-1897.
  • López Pujol J, Alvarez Kindelán A, Algar Algar J, Cerezo Madueño F, López Rivero L, Salvatierra Velázquez A. Perioperative morbimortality in pneumonectomy. Analysis of risk factors.Arch Bronconeumol. 2000;36:251-256.
  • Peter H. Hollaus, MD, Franz Lax, MD, PhD, Ba- sem B. El-Nashef, MD, Herwig H. Hauck, MD,Pa- olo Lucciarini, MD, Nestor S. Pridun, MD Natural History of Bronchopleural Fistula After Pneu- monectomy: A Review of 96 Cases. Ann Thorac Surg 1997;63:1391-1396.
  • JR Hankins, JE Miller, S Attar, JR Satterfield and JS McLaughlin. Bronchopleural fistula. Thirte- en-year experience with 77 cases. J Thorac Car- diovasc Surg. 1978;76:755-762.
  • Sirbu H, Busch T, Aleksic I, Schreiner W, Oster O, Dalichau H. Bronchopleural fistula in the sur- gery of non-small cell lung cancer: incidence, risk factors, and management. Ann Thorac Car- diovasc Surg. 2001;7: 330-336.
  • Alexiou C, Beggs D, Onyeaka P, Kotidis K, Ghosh S, Beggs L, et al. Pneumonectomy for stage I (T1N0 and T2N0) nonsmall cell lung cancer has potent, adverse impact on survival. Thorac Surg. 2003 Oct;76(4):1023-8.
  • Gökhan Yuncu, Ahmet Üçvet, Güven Olgaç, Serpil Sevinç, Hatice Alıc KHDAK Nedeniyle Cer- rahi Uygulanmış Olgularımız: 5 Yıllık Deneyim Türk Toraks Dergisi. 2004; 5: 13-19. experience. Surg Today. 2012;42(6):542-546.
There are 21 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Levent Alpay This is me

Tunç Laçin This is me

Hakan Kıral This is me

Aysun Mısırlıoğlu This is me

İlhan Ocakcıoğlu This is me

Tuğba Coşgun This is me

Volkan Baysungur This is me

İrfan Yalçınkaya This is me

Publication Date December 1, 2013
Published in Issue Year 2013 Volume: 5 Issue: 3

Cite

Vancouver Alpay L, Laçin T, Kıral H, Mısırlıoğlu A, Ocakcıoğlu İ, Coşgun T, Baysungur V, Yalçınkaya İ. Pnömonektomilerde Majör Mortalite ve Morbidite Kriterleri. Maltepe tıp derg. 2013;5(3):17-23.