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J Thorac Cardiovasc Surg 2001;122:841
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Determinants of perioperative morbidity and mortality after completion pneumonectomy

Department of Thoracic Surgery
First Hospital
Beijing Medical University
Xishiku Dajie 8, Xicheng Qu
Beijing 100034, The People&'s Republic of China

To the Editor:

I read with interest the article by Fujimoto and associates on completion pneumonectomy. ¹ Although the authors obtained a better result than that of some previous reports, the postoperative mortality rate, 7.6%, is still unacceptably high. To my knowledge, perioperative morbidity and mortality differ markedly among experienced surgeons. The mortality may be as high as 30% or as low as 2%, but the reason for the divergent results has not been established.

I think that the high perioperative morbidity and mortality are related to hemodilution. Hemodilution will increase the production of lymphatic fluid in the heart and lungs. ² The increased amount of lymphatic fluid cannot immediately drain through cardiopulmonary lymph ducts because of strong resistance in the mediastinal lymphatic system. ³ Thus, storage of excess lymphatic fluid in the heart and lungs may harm these organs. ^4,5

Hemodilution during the perioperative period is usually caused by large volume bleeding or excessive water input. I agree that completion pneumonectomy should be done by skilled thoracic surgeons to avoid major blood loss. In addition, strict control of water input is also important. Limitation of water may decrease the production of lymphatic fluid in the heart and lung.

12/8/117619

References

1. Fujimoto T, Zaboura G, Fechner S, Hillejan L, Schroder T, Marra A, et al. Completion pneumonectomy: indications, complications, and results. J Thorac Cardiovasc Surg. 2001;121:484-90.[Abstract/Free Full Text]
   
2. Drinker CK, Warren MF, Maurer FW, Mccarell JD. The flow, pressure and composition of cardiac lymph. Am J Physiol. 1940;130:43-55.[Free Full Text]
   
3. Drake RE, Allen SJ, Williams JP, Laine GA, Gabel JC. Lymph flow from edematous dog lungs. J Appl Physiol. 1987;62:2416-20.[Abstract/Free Full Text]
   
4. Cui Y. Pulmonary hemodynamic effects resulting from mediastinal lymphatic obstruction in anesthetized rabbits. Med Sci Res. 1999;27:345-8.
   
5. Cui Y, Urschel JD, Petrelli NJ. The effect of cardiopulmonary lymphatic obstruction on heart and lung function. Thorac Cardiovasc Surg. 2001;49:35-40.[Medline]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cui, Y. Search for Related Content PubMed PubMed Citation Articles by Cui, Y. Related Collections Lung - cancer Lung - basic science