Yazgan Serkan, Üçvet Ahmet, Gürsoy Soner, Samancılar Özgür
Department of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, İzmir, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2018 Sep 16;26(4):626-635. doi: 10.5606/tgkdc.dergisi.2018.16159. eCollection 2018 Oct.
This retrospective single-center study aims to review the indications and outcomes of completion pneumonectomy after primary resection due to non-small cell lung cancer.
Of a total of 452 patients who underwent pneumonectomy between January 2004 and August 2017 for non-small cell lung cancer, 29 (24 males, 5 females; mean age 59.9±7.1 years; range, 45 to 72 years) were performed completion pneumonectomy. Patients" indications, factors affecting early and late-term outcomes, operative mortality and survival rates were analyzed.
Operative mortality rate was 24.1%, including two intraoperative and five postoperative deaths. Complication rate was 44.8% and the most frequent complication was bronchopleural fistula with 24.1%. Study population was divided into two groups. While elective completion pneumonectomy group (n=19) consisted of recurrent malignant tumor patients, rescue completion pneumonectomy group (n=10) consisted of patients performed urgent pneumonectomy due to a bronchopulmonary complication developing after an anatomic lung resection. The morbidity and mortality rates for elective completion pneumonectomy and rescue completion pneumonectomy were 26.3% and 21.1%; and 70% and 30%, respectively. The morbidity for rescue completion pneumonectomy was significantly higher than elective completion pneumonectomy (p=0.016). Advanced age and presence of any preoperative risk (comorbidity and neoadjuvant treatment) were related to higher operative mortality (p=0.019 and p=0.049, respectively). The median survival after completion pneumonectomy was 19.5 months (95% confidence interval 17.2 to 21.9 months).
The morbidity and mortality rates of completion pneumonectomy are higher than standard pneumonectomy. Rescue completion pneumonectomy is related to higher postoperative risk, but has better survival. The most significant complication after completion pneumonectomy is bronchopleural fistula. Advanced age and presence of any preoperative risk are related to statistically significantly higher mortality in completion pneumonectomy. Nevertheless, completion pneumonectomy is still a significant treatment option in selected patients.
本回顾性单中心研究旨在回顾因非小细胞肺癌初次切除术后行全肺切除术的适应证及治疗结果。
在2004年1月至2017年8月期间，共有452例因非小细胞肺癌接受肺切除术的患者，其中29例（24例男性，5例女性；平均年龄59.9±7.1岁；范围45至72岁）接受了全肺切除术。分析了患者的适应证、影响早期和晚期结果的因素、手术死亡率和生存率。
手术死亡率为24.1%，包括2例术中死亡和5例术后死亡。并发症发生率为44.8%，最常见的并发症是支气管胸膜瘘，发生率为24.1%。研究人群分为两组。选择性全肺切除术组（n = 19）由复发性恶性肿瘤患者组成，挽救性全肺切除术组（n = 10）由因解剖性肺切除术后发生支气管肺并发症而进行紧急肺切除术的患者组成。选择性全肺切除术和挽救性全肺切除术的发病率和死亡率分别为26.3%和21.1%；以及70%和30%。挽救性全肺切除术的发病率明显高于选择性全肺切除术（p = 0.016）。高龄和任何术前风险（合并症和新辅助治疗）与较高的手术死亡率相关（分别为p = 0.019和p = 0.049）。全肺切除术后的中位生存期为19.5个月（95%置信区间17.2至21.9个月）。
全肺切除术的发病率和死亡率高于标准肺切除术。挽救性全肺切除术与较高的术后风险相关，但生存率较好。全肺切除术后最显著的并发症是支气管胸膜瘘。高龄和任何术前风险与全肺切除术中统计学上显著较高的死亡率相关。然而，全肺切除术仍然是特定患者的重要治疗选择。
