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2013 ; 95
(6
): 1885-90; discussion 1890-1
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Completion pneumonectomy: outcomes for benign and malignant indications
#MMPMID23647859
Puri V
; Tran A
; Bell JM
; Crabtree TD
; Kreisel D
; Krupnick AS
; Patterson GA
; Meyers BF
Ann Thorac Surg
2013[Jun]; 95
(6
): 1885-90; discussion 1890-1
PMID23647859
show ga
BACKGROUND: Past series have identified completion pneumonectomy (CP) as a
high-risk operation. We evaluated factors affecting outcomes of CP with a
selective approach to offering this operation. METHODS: We analyzed a prospective
institutional database and abstracted information on patients undergoing
pneumonectomy. Patients undergoing CP were compared with those undergoing primary
pneumonectomy (PP). RESULTS: Between January 2000 and February 2011, 211 patients
underwent pneumonectomy, of which 35 (17%) were CPs. Ten of 35 (29%) CPs were for
benign disease and 25 of 35 (71%) for cancer. Major perioperative morbidity was
seen in 21 of 35 (60%) with 4 (11%) perioperative deaths. In univariate analysis,
postoperative bronchopleural fistula (p = 0.05) and benign diagnosis (p = 0.07)
tended to be associated with perioperative mortality. All 10 patients undergoing
CP for benign disease developed a major complication compared with 11 of 25 (44%)
with malignancy, p = 0.002. A bronchopleural fistula (4 of 35, 11%) was more
likely to occur in patients undergoing CP shortly after the primary operation
(interval between lobectomy and CP; 0.28 vs 4.5 years; p = 0.018) with a trend
toward a benign indication for operation (p = 0.07). Median survival after CP for
benign and malignant indications was 24.3 months and 36.5 months, respectively.
Comparing CP patients to those undergoing PP (n = 176), CP patients were more
likely to undergo an operation for benign disease (10 of 35, 29% vs 14 of 176,
8%, p = 0.001). Perioperative mortality for PP was 10 of 176 (5.7%), and was
statistically similar to CP (11%). CONCLUSIONS: Despite a selective approach, CP
remains a morbid operation, particularly for benign indications. Rigorous
preoperative optimization, ruling out contraindications to operation and
attention to technical detail, are recommended.
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