Factors affecting early and long-term outcomes after completion pneumonectomy
Factors affecting early and long-term outcomes after completion pneumonectomy
复制标题
DOI：
10.1016/j.ejcts.2008.02.006
复制
发表时间：
2008-05-01
影响因子：
3.4
通讯作者：
Dartevelle, Philippe G.
中科院分区：
文献类型：
--
作者：
Chataigner, Olivier;Fadel, Elie;Dartevelle, Philippe G.
目的：探讨全肺切除术后影响手术死亡率、并发症及远期生存的因素。方法：我们回顾了1996年1月至2005年12月在我们心胸外科连续接受完全性全肺切除术的患者的图表。结果：本组病例共69例，占同期全肺切除手术的17.8%，其中良性病变22例，恶性病变47例(第二原发癌19例，局部复发17例，转移11例)。男50例，女19例，年龄29~80岁，平均60岁。术后死亡率为12%，术后并发症为41%。与术后死亡率相关的因素包括肥胖(p=0.005)、冠状动脉疾病(p=0.03)、右肺切除(p=0.02)、高龄(p=0.02)和肾功能衰竭(p<；0.0001)。多因素分析显示，术前肾功能衰竭是死亡率的唯一显著危险因素(p=0.036)。发生支气管胸膜瘘7例(10%)，危险因素为右肺切除(p=0.04)和机械缝合(p=0.03)。3年总存活率为65%，5年总存活率为46%。长期存活率不受完成全肺切除术原因的影响。结论：虽然长期存活是可以接受的，但术后死亡率和发病率仍然很高，证实了完全性全肺切除术是一项具有挑战性的手术。严重的合并症和右肺切除是术后死亡率的主要危险因素。改进患者选择和更好的术前肾功能衰竭处理可能会改善这一手术的术后结果，这为延长生存提供了机会。(C)2008年欧洲胸心外科协会。爱思唯尔出版，版权所有。
Objective: To identify factors that affect operative mortality and morbidity and tong-term survival after completion pneumonectomy. Methods: We retrospectively reviewed the charts of consecutive patients who underwent completion pneumonectomy at our cardiothoracic surgery department from January 1996 to December 2005. Results: We identified 69 patients, who accounted for 17.8% of all pneumonectomies during the study period; 22 had benign disease and 47 malignant disease (second primary lung cancer, n = 19; local recurrence, n = 17; or metastasis, n = 11). There were 50 mates and 19 females with a mean age of 60 years (range, 29-80 years). Postoperative mortality was 12% and postoperative morbidity 41%. Factors associated with postoperative mortality included obesity (p = 0.005), coronary artery disease (p = 0.03), removal of the right lung (p = 0.02), advanced age (p = 0.02), and renal failure (p < 0.0001). Preoperative renal failure was the only significant risk factor for mortality by multivariate analysis (p = 0.036). Bronchopleural fistula developed in seven patients (10%), with risk factors being removal of the right lung (p = 0.04) and mechanical stump closure (p, = 0.03). Overall survival was 65% after 3 years and 46% after 5 years. Long-term survival was not affected by the reason for completion pneumonectomy. Conclusion: Although long-term survival was acceptable, postoperative mortality and morbidity rates remained high, confirming the reputation of completion pneumonectomy as a challenging procedure. Significant comorbidities and removal of the right lung were the main risk factors for postoperative mortality. Improved patient selection and better management of preoperative renal failure may improve the postoperative outcomes of this procedure, which offers a chance for prolonged survival. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.