Risk of a right pneumonectomy: role of bronchopleural fistula.
BACKGROUND
The purpose of this study is to compare the morbidity and mortality of right versus left pneumonectomy.


METHODS
We used a retrospective review of pneumonectomies performed during the period 1990 to 2000 and included a meta-analysis of relevant literature.


RESULTS
There were 187 pneumonectomies: 68 right, 119 left. The primary study end point was in-hospital death. There were 11 deaths: 7 (10.3%) right, 4 (3.3%) left (p = 0.10). Six deaths were attributable to bronchopleural fistula and its subsequent complications. The risk of bronchopleural fistula was higher on the right (9 [13.2%]) versus left (6 [5.0%]; p = 0.0472), as was the mortality associated with bronchopleural fistula (4 of 9 [44%] right versus 2 of 6 [33%] left). Right pneumonectomies were more likely to require an intrapericardial or extended dissection (p = 0.003), hand-sewn bronchial closure (p < 0.0001), or the closure buttressed (p < 0.0001). By univariate analysis, factors associated with an increased mortality were bronchopleural fistula (p < 0.0001), hand-sewn closure (p = 0.001), and a history of smoking (p = 0.01). By multivariate analysis, the most important factor was bronchopleural fistula (odds ratio, 43.3; 95% confidence limits, 4.2 to 441.9; p = 0.002). A meta-analysis combining our results with those from the literature found increased mortality of right pneumonectomy with a relative risk of 3.39 (95% confidence limits, 2.10 to 5.48; p < 0.00001).


CONCLUSIONS
Right pneumonectomy is associated with a higher mortality even in the absence of induction therapy. This is primarily related to the increased risk of bronchopleural fistula on the right. The increased number of bronchopleural fistulas on the right may be attributable to more extensive resection. Addressing technical factors that contribute to early bronchopleural fistula may reduce the mortality of right pneumonectomy.
Darling
Gail E
GE
Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada. gail.darling@uhn.on.ca
Abdurahman
Adel
A
Yi
Qi-Long
QL
Johnston
Michael
M
Waddell
Thomas K
TK
Pierre
Andrew
A
Keshavjee
Shaf
S
Ginsberg
Robert
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D002423:Cause of Death; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010995:Pleural Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate