Linden Philip A, Yeap Beow Y, Chang Michael Y, Henderson William G, Jaklitsch Michael T, Khuri Shukri, Sugarbaker David J, Bueno Raphael
Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Thorac Surg. 2007 Feb;83(2):425-31; discussion 432. doi: 10.1016/j.athoracsur.2006.09.081.
Lobectomy is the current standard operation for localized lung cancer. Patients who undergo lobectomy have a 1% to 2% chance per year of developing a second lung cancer. The risks of repeat lung resection have not been well quantified or analyzed. We used a national, prospectively recorded database to evaluate the complication rate and risk factors in this population.
The Veterans Affairs National Surgical Quality Improvement Program Database was queried for all patients who underwent lobectomy, followed by an additional lung resection, between 1994 and 2002. Preoperative variables, intraoperative variables, and complications were analyzed. Pulmonary function data were not collected.
Excluding 17 patients who underwent repeat resection for complications of lobectomy, 186 patients underwent 191 repeat resections. The 30-day mortality was 11%; the complication rate was 19%. Mortality for pneumonectomy was 34%, lobectomy, 7%; segmentectomy, 0%; and wedge resection, 6%. The most frequent complications were pneumonia (9%), reintubation (8%), ventilator dependence (6%), cardiac arrest (3%), dysrhythmia (3%), and sepsis (3%). Multivariate analysis revealed that operative time exceeding 2 hours, preoperative dyspnea at rest or with minimal exertion, and white blood cell count of more than 10,000/mm3 were predictors of complication. Presence of a contaminated/infected case, pneumonectomy, and intraoperative transfusion were predictors of death. Age, complications from prior lobectomy, time interval between lobectomy and repeat resection, smoking history, other comorbidities, and preoperative laboratory values were not independent predictors.
Repeat lung resection after lobectomy carries an 11% overall mortality predicted by the presence of a contaminated/infected case, need for intraoperative transfusion, and pneumonectomy versus a lesser resection.
肺叶切除术是目前治疗局限性肺癌的标准手术。接受肺叶切除术的患者每年有1%至2%的几率发生第二次肺癌。再次肺切除的风险尚未得到充分量化或分析。我们使用了一个全国性的前瞻性记录数据库来评估该人群的并发症发生率和风险因素。
查询退伍军人事务部国家外科质量改进计划数据库中1994年至2002年间接受肺叶切除术，随后又进行了一次肺切除的所有患者。分析术前变量、术中变量和并发症。未收集肺功能数据。
排除17例因肺叶切除术后并发症而接受再次切除的患者，186例患者进行了191次再次切除。30天死亡率为11%；并发症发生率为19%。全肺切除术的死亡率为34%，肺叶切除术为7%，肺段切除术为0%，楔形切除术为6%。最常见的并发症是肺炎（9%）、再次插管（8%）、呼吸机依赖（6%）、心脏骤停（3%）、心律失常（3%）和败血症（3%）。多因素分析显示，手术时间超过2小时、术前静息或轻微活动时出现呼吸困难以及白细胞计数超过10000/mm³是并发症的预测因素。存在污染/感染病例、全肺切除术和术中输血是死亡的预测因素。年龄、先前肺叶切除术的并发症、肺叶切除术与再次切除之间的时间间隔、吸烟史、其他合并症以及术前实验室值不是独立的预测因素。
肺叶切除术后再次肺切除的总体死亡率为11%，其预测因素为存在污染/感染病例、术中输血的需要以及全肺切除术与较小切除手术相比。
