Department of Cardiothoracic surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Cardiology, Section for Lung Transplantation and Respiratory Medicine, Rigshospitalet, Copenhagen, Denmark.
Surg Endosc. 2024 Feb;38(2):679-687. doi: 10.1007/s00464-023-10559-z. Epub 2023 Nov 28.
Lung volume reduction surgery (LVRS) has proven an effective treatment for emphysema, by decreasing hyperinflation and improving lung function, activity level and reducing dyspnoea. However, postoperative air leak is an important complication, often leading to reoperation. Our aim was to analyse reoperations after LVRS and identify potential predictors.
Consecutive single-centre unilateral VATS LVRS performed from 2017 to 2022 were included. Typically, 3-5 minor resections were made using vascular magazines without buttressing. Data were obtained from an institutional database and analysed. Multivariable logistic regression was used to identify predictors of reoperation. Number and location of injuries were registered.
In total, 191 patients were included, 25 were reoperated (13%). In 21 patients, the indication for reoperation was substantial air leak, 3 patients bleeding and 1 patient empyema. Length of stay (LOS) was 21 (11-33) vs. 5 days (3-11), respectively. Only 3 injuries were in the stapler line, 13 within < 2cm and 15 injuries were in another site. Multivariable logistic regression analysis showed that decreasing DLCO increased risk of reoperation, OR 1.1 (1.03, 1.18, P = 0.005). Resections in only one lobe, compared to resections in multiple lobes, were also a risk factor OR 3.10 (1.17, 9.32, P = 0.03). Patients undergoing reoperation had significantly increased 30-day mortality, OR 5.52 (1.03, 26.69, P = 0.02).
Our incidence of reoperation after LVRS was 13% leading to prolonged LOS and increased 30-day mortality. Low DLCO and resections in a single lobe were significant predictors of reoperation. The air leak was usually not localized in the stapler line.
肺减容手术（LVRS）通过减少过度充气、改善肺功能、活动水平和减轻呼吸困难，已被证实是治疗肺气肿的有效方法。然而，术后肺漏气是一个重要的并发症，常导致再次手术。我们的目的是分析 LVRS 后的再次手术，并确定潜在的预测因素。
纳入 2017 年至 2022 年期间在单中心行单侧电视辅助胸腔镜下 LVRS 的连续病例。通常采用血管夹进行 3-5 个小切除，不使用支撑物。数据来自机构数据库并进行分析。多变量逻辑回归用于识别再次手术的预测因素。记录损伤的数量和位置。
共纳入 191 例患者，25 例（13%）再次手术。21 例再次手术的指征为明显的肺漏气，3 例为出血，1 例为脓胸。住院时间（LOS）分别为 21 天（11-33 天）和 5 天（3-11 天）。只有 3 处损伤位于吻合器线，13 处损伤位于<2cm 内，15 处损伤位于其他部位。多变量逻辑回归分析显示，DLCO 降低会增加再次手术的风险，OR 1.1（1.03，1.18，P=0.005）。与多叶切除相比，仅一叶切除也是一个危险因素，OR 3.10（1.17，9.32，P=0.03）。再次手术患者的 30 天死亡率显著增加，OR 5.52（1.03，26.69，P=0.02）。
我们 LVRS 后再次手术的发生率为 13%，导致 LOS 延长和 30 天死亡率增加。低 DLCO 和单叶切除是再次手术的显著预测因素。漏气通常不在吻合器线处。
