Prospective analysis of pneumonectomy: Risk factors for major morbidity and cardiac dysrhythmias
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392 Abstructs / Lung Cuncrr 15 (1996) 381-399 agnosis, but diabetes (14.3%versus 5%) and fever (286%versus 13.5%) were significantly more frequent in group I than in group II. No statis- tically significant difference was observed between the two groups in tumor site or endoscopic appearance. Cavitated tumors were I s times larger than the noncavitated lesions. Squamous cell carcinoma was sig- nificantly more frequent in group I than in group II (82.8% versus 61%). Survival at 1, 3, and 5 years was, respectively, 58.6%0/o, 36. I%, and 22.2% in group I versus 48.2%. 3S%, and 23.8% in group II. Con- clusions. Despite several specific features, there appears to be no justifica- tion for considering cavitated neoplasms separately from other forms of lung cancer. Transtracheal aspiration using rigid hronchoscopy and a rigid needle for investigating mediastinal masses Wilsher ML, Gurley AM. Department ofRespiratop Medicine, Green Lane Hospital, Auckland 3. Thorax 1996;s 1: 191-9. Background - Use of the flexible needle via the tibre-optic bron- choscope to aspirate mediastinal nodes or masses has largely super- seded the use of the rigid needle via the rigid bronchoscope. However, the yield at fibreoptic bronchoscopy is relatively low, although this im- proves with the use of a wider gauge needle. In this study the sensitivity and the safety of rigid needle sampling of the mediastinum in the diag- nosis of lung cancer is evaluated. Methods - Transtracheal needle aspi- ration (TTNA) was performed with the rigid bronchoscope and a rigid aspiration needle under general anaesthesia using a previous computed tomographic (CT) scan as a guide to the sample site. A cytopathologist immediately examined the specimens for adequacy and preliminary diagnosis, thus determining the number of aspirations. Results - Twenty four patients were evaluated. The diagnostic sensitivity of TTNA was 88%. This led to a management decision in 2 1 patients. There were no false positives and no complications. Conclusions - TTNA using the rigid bronchoscope with CT scanning and a cytopathologist present is a sensitive and safe way of diagnosing lung cancer in patients with a mediastinal mass or enlarged mediastinal nodes. Surgery Long-term outcome after pneumonectomy for nonsmall cell lung cancer Rocco PM, Antkowiak JG, Takita H, Urschel JD. Division oJThoracic Surgery, RosweN Park Cancer Institute, Elm and Carlton Streets, Bujjalo, NY 14263-0001. J Surg Oncol 1996;61:278-80. Long-term survivors (5 or more years) of pneumonectomy for nonsmall cell lung cancer are at risk for late death from cancer recur- rence, second primary malignancies, and cardiopulmonary insufficiency related to the adverse physiological effects of pneumonectomy. A retrospective study of pneumoncctomy patients was done to quantify the risks of late death from these causes. Of 246 patients treated for nonsmall cell lung cancer by pneumonectomy. medical records of 49 who survived 5 or more years were reviewed. Follow-up for the 49 long-term survivors ranged from 60 to 240 months, with a mean of II 3 months. Twenty-five (5 1%) ofthe long-term survivors were alive at the time of the study. Twenty-four (49%) had died. Causes of death included late lung cancer recurrence (6 patients). second primaly malignancies (7 patients), cardiopulmonary insufficiency (4 patients), and miscellaneous causes unrelated to cancer and its treatment (7 patients). Long-term survival after pneumonectomy for nonsmall cell lung cancer occurs in 20% of patients. Late lung cancer recurrence and second primary malignancies are important causes of death in these patients. Late cardiopulmonary insufficiency related to adverse physiological consequences of pneumonectomy is uncommon. Long-term follow-up is recommended afler pneumonectomy for nonsmall cell lung cancer Postoperative complications after pneumonectomy for treatment of lung cancer: Multivariate analysis Mitsudomi T, Mizoue T, Yoshimatsu T, Oyama T, Nakanishi R, Okabayashi K et al. Department oJ Thoracic Surgery, Aichi Cancer Center Hospital, I-1 Kanokoden, Chikusa-ku. Nagoya 464. J S~rg On~l 1996,61:218-22. The charts of62 patients with primary lung cancer who underwent a pneumonectomy at our department from 1979 through 1992 were reviewed for the evaluation of postoperative morbidity and mortality. The 30day mortality was 3/62 or 4.8%. Postoperative complication occurred in 37 of 62 patients (60%). The most common complication was a supraventricular tachya@hmia. A major complication, which was detined as one necessitating re-thoracotomy or one which caused death, occurred in 19 patients (31%). We analyzed 43 perioperative variables for their predictive value of postoperative morbidity and mortality. Univariate analysis indicated that an elevated serum LDH, low predicted forced vital capacity, low predicted forced expiratoly volume in I set (FEV,) were significantly associated with the occurrence of a major complication. A multivariate logistic regression model indicated that a high LDH level, a low predicted FEV, and no extubation following surgery were associated independently with a postoperative major complication. Since only the complete removal of a tumor offers a chance for cure for the treatment of non-small cell lung cancer, it is sometimes necessary to perform a pneumonectomy for these high-risk patients. Patients identified as being at high risk of a major complication should be candidates for intensive preoperative evaluation and perioperative care. Prospective analysis of pneumoncctomy: Risk factors for major morbidity and cardiac dysrhytlunias Harpole DH Jr, Liptay MJ, DeCamp MM Jr, Mentzer SJ, Swanson SJ, Sugarbaker DJ. Division Thoracic Surgery, Brigham and Women S Hospital, 75 Francis Street, Boston, UA 02115. Ann Thorac Surg 1996;61:977-82. Background. Data were acquired prospectively on I36 consecutive patients undergoing pneumonectomy for cancer from 1988 to 1993, to define factors that increase the risk of major morbidity and postoperative cardiac dysrhythmias. Methods. There were 81 patients (60%) with non-small cell lung cancer (standard pneumonectomy) and 55 patients (40%) with malignant pleural mesothelioma (extrapleural pneumonectomy). Results. Four perioperative deaths occurred (3%) with no identifiable associated risk factors. tienty-three patients (I 7%) had a major complication with an increase in the median length of stay from 7 to 11 days @ < 0.01). Age greater than 65 years, right-sided procedures, and dysrhythmias were associated with an increased risk of a major complication (p < 0.0s). Thirty-two patients (24%) had supraventricular dysrhythmias, which occurred on postoperative days I to 2 (n = 8). 3 to 4 (n = 13), 5 to 6 (n = 6). and 7 to 12 (n = 5). The median length of stay increased from 8 to 11 days with dysrhythmias (p < 0.05). Factors associated with an increased risk of dysrhythmias (p < 0.05) included age greater than 65 years, intrapcricardial or extrapleural pneumoncctomy, right-sided procedure, and any major complication. Conclusions. Pneumonectomy can be performed safely in selected patients with cancer. Supraventricular dysrhythmia was the most common complication noted with a peak incidence at 3 to 4 days after resection. Lymphadenectomy in non-small cell lung cancer Gellert K, Agnes A, Noack F, Benhidjeb T, Jacobi C. Klinik und Poltklinik fur Chirmgie. llniversitatsklinikum Charite, Schumannst,: 20121, 10098 Berlin. Zentralbl Chir 1996;121:87-9. Since I982 a total number of 1062 patients underwent surgical treatment Of bronchogenic carcinoma. There were 972 men and 89
Transcript of Prospective analysis of pneumonectomy: Risk factors for major morbidity and cardiac dysrhythmias
392 Abstructs / Lung Cuncrr 15 (1996) 381-399
agnosis, but diabetes (14.3%versus 5%) and fever (286%versus 13.5%) were significantly more frequent in group I than in group II. No statis- tically significant difference was observed between the two groups in tumor site or endoscopic appearance. Cavitated tumors were I s times larger than the noncavitated lesions. Squamous cell carcinoma was sig- nificantly more frequent in group I than in group II (82.8% versus 61%). Survival at 1, 3, and 5 years was, respectively, 58.6%0/o, 36. I%, and 22.2% in group I versus 48.2%. 3S%, and 23.8% in group II. Con- clusions. Despite several specific features, there appears to be no justifica- tion for considering cavitated neoplasms separately from other forms of lung cancer.
Transtracheal aspiration using rigid hronchoscopy and a rigid needle for investigating mediastinal masses Wilsher ML, Gurley AM. Department ofRespiratop Medicine, Green Lane Hospital, Auckland 3. Thorax 1996;s 1: 191-9.
Background - Use of the flexible needle via the tibre-optic bron- choscope to aspirate mediastinal nodes or masses has largely super- seded the use of the rigid needle via the rigid bronchoscope. However, the yield at fibreoptic bronchoscopy is relatively low, although this im- proves with the use of a wider gauge needle. In this study the sensitivity and the safety of rigid needle sampling of the mediastinum in the diag- nosis of lung cancer is evaluated. Methods - Transtracheal needle aspi- ration (TTNA) was performed with the rigid bronchoscope and a rigid aspiration needle under general anaesthesia using a previous computed tomographic (CT) scan as a guide to the sample site. A cytopathologist immediately examined the specimens for adequacy and preliminary diagnosis, thus determining the number of aspirations. Results - Twenty four patients were evaluated. The diagnostic sensitivity of TTNA was 88%. This led to a management decision in 2 1 patients. There were no false positives and no complications. Conclusions - TTNA using the rigid bronchoscope with CT scanning and a cytopathologist present is a sensitive and safe way of diagnosing lung cancer in patients with a mediastinal mass or enlarged mediastinal nodes.
Surgery
Long-term outcome after pneumonectomy for nonsmall cell lung cancer Rocco PM, Antkowiak JG, Takita H, Urschel JD. Division oJThoracic Surgery, RosweN Park Cancer Institute, Elm and Carlton Streets, Bujjalo, NY 14263-0001. J Surg Oncol 1996;61:278-80.
Long-term survivors (5 or more years) of pneumonectomy for nonsmall cell lung cancer are at risk for late death from cancer recur- rence, second primary malignancies, and cardiopulmonary insufficiency related to the adverse physiological effects of pneumonectomy. A retrospective study of pneumoncctomy patients was done to quantify the risks of late death from these causes. Of 246 patients treated for nonsmall cell lung cancer by pneumonectomy. medical records of 49 who survived 5 or more years were reviewed. Follow-up for the 49 long-term survivors ranged from 60 to 240 months, with a mean of II 3 months. Twenty-five (5 1%) ofthe long-term survivors were alive at the time of the study. Twenty-four (49%) had died. Causes of death included late lung cancer recurrence (6 patients). second primaly malignancies (7 patients), cardiopulmonary insufficiency (4 patients), and miscellaneous causes unrelated to cancer and its treatment (7 patients). Long-term survival after pneumonectomy for nonsmall cell lung cancer occurs in 20% of patients. Late lung cancer recurrence and second primary malignancies are important causes of death in these patients. Late cardiopulmonary insufficiency related to adverse physiological consequences of pneumonectomy is uncommon. Long-term follow-up is recommended afler pneumonectomy for nonsmall cell lung cancer
Postoperative complications after pneumonectomy for treatment of lung cancer: Multivariate analysis Mitsudomi T, Mizoue T, Yoshimatsu T, Oyama T, Nakanishi R, Okabayashi K et al. Department oJ Thoracic Surgery, Aichi Cancer Center Hospital, I-1 Kanokoden, Chikusa-ku. Nagoya 464. J S~rg On~l 1996,61:218-22.
The charts of62 patients with primary lung cancer who underwent a pneumonectomy at our department from 1979 through 1992 were reviewed for the evaluation of postoperative morbidity and mortality. The 30day mortality was 3/62 or 4.8%. Postoperative complication occurred in 37 of 62 patients (60%). The most common complication was a supraventricular tachya@hmia. A major complication, which was detined as one necessitating re-thoracotomy or one which caused death, occurred in 19 patients (31%). We analyzed 43 perioperative variables for their predictive value of postoperative morbidity and mortality. Univariate analysis indicated that an elevated serum LDH, low predicted forced vital capacity, low predicted forced expiratoly volume in I set (FEV,) were significantly associated with the occurrence of a major complication. A multivariate logistic regression model indicated that a high LDH level, a low predicted FEV, and no extubation following surgery were associated independently with a postoperative major complication. Since only the complete removal of a tumor offers a chance for cure for the treatment of non-small cell lung cancer, it is sometimes necessary to perform a pneumonectomy for these high-risk patients. Patients identified as being at high risk of a major complication should be candidates for intensive preoperative evaluation and perioperative care.
Prospective analysis of pneumoncctomy: Risk factors for major morbidity and cardiac dysrhytlunias Harpole DH Jr, Liptay MJ, DeCamp MM Jr, Mentzer SJ, Swanson SJ, Sugarbaker DJ. Division Thoracic Surgery, Brigham and Women S Hospital, 75 Francis Street, Boston, UA 02115. Ann Thorac Surg 1996;61:977-82.
Background. Data were acquired prospectively on I36 consecutive patients undergoing pneumonectomy for cancer from 1988 to 1993, to define factors that increase the risk of major morbidity and postoperative cardiac dysrhythmias. Methods. There were 81 patients (60%) with non-small cell lung cancer (standard pneumonectomy) and 55 patients (40%) with malignant pleural mesothelioma (extrapleural pneumonectomy). Results. Four perioperative deaths occurred (3%) with no identifiable associated risk factors. tienty-three patients (I 7%) had a major complication with an increase in the median length of stay from 7 to 11 days @ < 0.01). Age greater than 65 years, right-sided procedures, and dysrhythmias were associated with an increased risk of a major complication (p < 0.0s). Thirty-two patients (24%) had supraventricular dysrhythmias, which occurred on postoperative days I to 2 (n = 8). 3 to 4 (n = 13), 5 to 6 (n = 6). and 7 to 12 (n = 5). The median length of stay increased from 8 to 11 days with dysrhythmias (p < 0.05). Factors associated with an increased risk of dysrhythmias (p < 0.05) included age greater than 65 years, intrapcricardial or extrapleural pneumoncctomy, right-sided procedure, and any major complication. Conclusions. Pneumonectomy can be performed safely in selected patients with cancer. Supraventricular dysrhythmia was the most common complication noted with a peak incidence at 3 to 4 days after resection.
Lymphadenectomy in non-small cell lung cancer Gellert K, Agnes A, Noack F, Benhidjeb T, Jacobi C. Klinik und Poltklinik fur Chirmgie. llniversitatsklinikum Charite, Schumannst,: 20121, 10098 Berlin. Zentralbl Chir 1996;121:87-9.
Since I982 a total number of 1062 patients underwent surgical treatment Of bronchogenic carcinoma. There were 972 men and 89
