Determinants of Perioperative Morbidity and Mortality after Pneumonectomy

Abstract

Background: Pneumonectomy remains a relatively high-risk procedure. However, the underlying mechanism is still unknown. Thus, the effort to find out predisposing factors for surgical risks continues. We investigated the effect of both water-load control and sampling lymphadenectomy technique on perioperative morbidity and mortality after pneumonectomy. Material and Methods: A hundred and three consecutive patients undergoing simple pneumonectomy were included in the prospective study. Pneumonectomy was performed for lung cancer in 92 patients and for benign diseases in 11 cases; 81 patients were male and 22 female, and the mean age was 53.4 ± 11.4 years. Both sampling and completion lymphadenectomy techniques were used randomly. Water-load was carefully limited to values as low as possible, depending on stable hemodynamics during and after operation. Results: There were no deaths, and none of the patients needed postoperative mechanical ventilation. Major complications included dyspnea in 9 patients and supraventricular arrhythmias in 13 patients. Completion lymphadenectomy increased morbidity in both right and left pneumonectomy. Conclusions: Both water-load limitation and sampling lymphadenectomy technique may decrease morbidity and mortality after pneumonectomy.

Pneumonectomy - lymphadenectomy - water load - morbidity - mortality

References

• 1 Wahi R, McMurtrey M J, DeCaro L F, Mountain C F, Ali M K, Smith T L, Roth J A. Determinants of perioperative morbidity and mortality after pneumonectomy.  Ann Thorac Surg. 1989;  48 33-37
• 2 Wada H, Nakamura T, Nakamoto K, Maeda M, Watanabe Y. Thirty day operative mortality for thoracotomy in lung cancer.  J Thorac Cardiovasc Surg. 1998;  115 70-73
• 3 Klemperer J, Ginsberg R J. Morbidity and mortality after pneumonectomy.  Chest Surg Clin N Am. 1999;  9 515-525
• 4 Foroulis C N, Kotoulas C, Lachanas H, Lazopoulos G, Konstantinou M, Lioulias A G. Factors associated with cardiac rhythm disturbances in the early post-pneumonectomy period: a study of 259 pneumonectomies.  Eur J Cardiothorac Surg. 2003;  23 384-389
• 5 Weiss W. Operative mortality and five year survival rates in patients with bronchogenic carcinoma.  Chest. 1974;  66 483-487
• 6 Reichel J. Assessment of operative risk of pneumonectomy.  Chest. 1972;  62 570-576
• 7 Kohman L J, Meyer J A, Ikins P M, Oates R P. Random vs. predictable risks of mortality after thoracotomy for lung cancer.  J Thorac Cardiovasc Surg. 1986;  91 551-554
• 8 Ginsberg R J, Hill L D, Eagan R T. et al . Modern thirty day mortality for surgical resection in lung cancer.  J Thorac Cardiovasc Surg. 1983;  86 654-658
• 9 Patel R L, Townsend E R, Fountain S W. Elective pneumonectomy: factors associated with morbidity and operative mortality.  Ann Thorac Surg. 1992;  54 84-88
• 10 Swartz D E, Lachapelle K, Sampalis J, Mulder D S, Chiu R C, Wilson J. Perioperative mortality after pneumonectomy. Analysis of risk factors and review of literature.  Can J Surg. 1997;  40 437-444
• 11 Drinker C K, Warren M F, Maurer F W, Mccarell J D. The flow, pressure and composition of cardiac lymph.  Am J Physiol. 1940;  130 43-55
• 12 Drake R E, Allen S J, Williams J P, Laine G A, Gabel J C. Lymph flow from edematous dog lungs.  J Appl Physiol. 1987;  62 2416-2420
• 13 Cui Y. Pulmonary hemodynamic effects resulting from mediastinal lymphatic obstruction in anesthetized rabbits.  Med Sci Res. 1999;  27 345-348
• 14 Cui Y, Urechel J D, Petrelli N J. The effect of cardiopulmonary lymphatic obstruction on heart and lung function.  Thorac Cardiovasc Surg. 2001;  49 35-40
• 15 Cui Y. Determinants of perioperative morbidity and mortality after completion pneumonectomy.  J Thorac Cardiovasc Surg. 2001;  122 841
• 16 Harpole D H, Liptay M J, Decamp Jr M M, Mentzer S T, Swanson S J, Sugarbaker D J. Prospective analysis of pneumonectomy: risk factors for major morbidity and cardiac dysrhythmias.  Ann Thorac Surg. 1996;  61 977-982
• 17 Mitsudomi T, Mizoue T, Yoshimatsu T. et al . Postoperative complications after pneumonectomy for treatment of lung cancer. Multivariate analysis.  J Surg Oncol. 1996;  61 218-222