Complications and Predictive Factors for Air Leak > 10 Days with Neoadjuvant Chemotherapy Followed by Pleurectomy/Decortication for Malignant Pleural Mesothelioma
Complications and Predictive Factors for Air Leak > 10 Days with Neoadjuvant Chemotherapy Followed by Pleurectomy/Decortication for Malignant Pleural Mesothelioma
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恶性胸膜间皮瘤新辅助化疗继之以胸膜切除术/去皮质术 10 天后发生气漏的并发症和预测因素
DOI：
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发表时间：
2020
影响因子：
3.7
通讯作者：
S. Hasegawa
中科院分区：
文献类型：
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作者：
A. Nakamura;N. Kondo;T. Nakamichi;M. Hashimoto;T. Takuwa;S. Matsumoto;K. Kuribayashi;T. Kijima;S. Hasegawa
一些研究报告了胸膜切除/皮质剥脱 (P/D) 后并发症的发生率和临床意义。本研究的目的是评估 P/D 特别持久漏气的并发症细节和预测因素。回顾性分析了 2012 年 9 月至 2020 年 5 月期间在我们机构接受新辅助化疗 (NAC) 随后进行 P/D 的恶性胸膜间皮瘤连续 163 例患者的数据。研究了术后并发症以及各种术前漏气 > 10天（AL10）危险因素的重要性，以识别具有特别持久漏气风险较高的群体。使用单变量和多变量分析寻找 AL10 的危险因素。 163 名患者中，30 天和 90 天死亡率分别为 0.6% 和 2.5%。根据 Clavien-Dindo 分类，84 名 (51.4%) 患者经历了 III 级或更严重的术后并发症。漏气的中位持续时间为术后 7 天。 53 名 (32.5%) 患者发生 AL10。 58 名患者（35.6%）接受了胸膜固定术，5 名患者（3.1%）接受了再次手术以控制漏气。在单变量分析中，体能状态（PS；p = 0.003）、预后营养指数（p = 0.01）和胸腔积液（p = 0.04）是 AL10 具有统计学意义的危险因素，而在多变量分析中，PS（比值比 4.0，95% 置信区间 1.3-12.7； p = 0.02）仍然是 AL10 的唯一预测变量。最近 NAC 和 P/D 的术后死亡率是可以接受的。大约三分之一的患者经历过 AL10，PS 可能是与 AL10 相关的危险因素。
A few studies have reported the incidence and clinical implications of complications after pleurectomy/decortication (P/D). The aim of this study was to assess the details of complications and predictive factors of particularly durable air leak with P/D. Data on 163 consecutive patients who underwent neoadjuvant chemotherapy (NAC) followed by P/D for malignant pleural mesothelioma between September 2012 and May 2020 at our institution were retrospectively analyzed. Postoperative complications and the significance of various preoperative risk factors for air leak > 10 days (AL10) to identify the group having a higher risk for particularly durable air leak were investigated. Risk factors for AL10 were sought using univariate and multivariate analyses. Of 163 patients, 30- and 90-day mortality was 0.6% and 2.5%, respectively. Eighty-four (51.4%) patients experienced grade III or worse postoperative complications according to the Clavien–Dindo classification. The median duration of air leak was 7 postoperative days. AL10 occurred in 53 (32.5%) patients. Fifty-eight patients (35.6%) underwent pleurodesis and five patients (3.1%) underwent reoperation to control the air leak. On univariate analysis, performance status (PS; p = 0.003), prognostic nutritional index (p = 0.01), and pleural effusion (p = 0.04) were statistically significant risk factors for AL10, while on multivariate analysis, PS (odds ratio 4.0, 95% confidence interval 1.3–12.7; p = 0.02) remained the only variable predicted for AL10. Recent postoperative mortality rates in NAC followed by P/D are quite acceptable. Approximately one in every three patients experienced AL10, and PS may be a risk factor associated with AL10.