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J Thorac Cardiovasc Surg 2001;121:1076-1082
© 2001 The American Association for Thoracic Surgery
General Thoracic Surgery |
From the Division of General Thoracic Surgerya and the Section of Biostatistics,b Mayo Clinic and Mayo Foundation, Rochester, Minn.
Received for publication May 8, 2000. Revisions requested July 11, 2000; revisions received Jan 9, 2001. Accepted for publication Jan 10, 2001. Address for reprints: Claude Deschamps, MD, Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, 200 First St, SW, Rochester, MN 55905 (E-mail: deschamps.claude{at}mayo.edu).
Objective: The purpose of this report is to analyze factors affecting morbidity and mortality after pneumonectomy for malignant disease.
Methods: We retrospectively reviewed the cases of all patients who underwent pneumonectomy for malignancy at the Mayo Clinic. Between January 1, 1985, and September 30, 1998, 639 patients (469 men and 170 women) were identified. Median age was 64 years (range 20 to 86 years). Indication for pneumonectomy was primary lung cancer in 607 (95.0%) patients and metastatic disease in 32 (5.0%). Factors affecting morbidity and mortality were analyzed by univariate and multivariate analysis.
Results: Cardiopulmonary complications occurred in 245 patients (38.3%; 95% confidence interval 34.6%-42.2%). Factors adversely affecting morbidity with univariate analysis included age (P < .0001), male sex (P = .04), associated respiratory (P = .02) or cardiovascular disease (P < .0001), cigarette smoking (P = .02), decreased vital capacity (P = .01), forced expiratory volume in 1 second (P < .0001), forced vital capacity (P = .002), diffusion capacity of the lung to carbon monoxide (P = .005), oxygen saturation (P < .05), arterial PO2 (P = .007), preoperative radiation (P = .02), bronchial stump reinforcement (P = .007), crystalloid infusion (P = .01), and blood transfusion (P = .02). Factors adversely affecting morbidity with multivariate analysis included age (P = .0001), associated cardiovascular disease (P = .001), and bronchial stump reinforcement (P = .0005). There were 45 deaths (7.0%; 95% confidence intervals 5.2%-9.3%). Factors adversely affecting mortality with univariate analysis included associated cardiovascular (P < .0001) or hematologic disease (P < .005), lower preoperative serum hemoglobin level (P = .004), preoperative chemotherapy (P = .01), decreased diffusion capacity of lung to carbon monoxide (P = .002), right pneumonectomy (P = .0006), extended resection (P = .04), bronchial stump reinforcement (P = .007), and crystalloid infusion (P = .01). Factors affecting mortality with multivariate analysis included hematologic disease (P = .01), lower preoperative serum hemoglobin (P = .003), and completion pneumonectomy (P = .01).
Conclusion: Multiple factors adversely affected morbidity and mortality after pneumonectomy for malignant disease. Appropriate selection and meticulous perioperative care are paramount to minimize risks in those patients who require pneumonectomy.
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