Factors affecting early and long-term outcomes after completion pneumonectomy.
OBJECTIVE
To identify factors that affect operative mortality and morbidity and long-term survival after completion pneumonectomy.


METHODS
We retrospectively reviewed the charts of consecutive patients who underwent completion pneumonectomy at our cardiothoracic surgery department from January 1996 to December 2005.


RESULTS
We identified 69 patients, who accounted for 17.8% of all pneumonectomies during the study period; 22 had benign disease and 47 malignant disease (second primary lung cancer, n=19; local recurrence, n=17; or metastasis, n=11). There were 50 males and 19 females with a mean age of 60 years (range, 29-80 years). Postoperative mortality was 12% and postoperative morbidity 41%. Factors associated with postoperative mortality included obesity (p=0.005), coronary artery disease (p=0.03), removal of the right lung (p=0.02), advanced age (p=0.02), and renal failure (p<0.0001). Preoperative renal failure was the only significant risk factor for mortality by multivariate analysis (p=0.036). Bronchopleural fistula developed in seven patients (10%), with risk factors being removal of the right lung (p=0.04) and mechanical stump closure (p=0.03). Overall survival was 65% after 3 years and 46% after 5 years. Long-term survival was not affected by the reason for completion pneumonectomy.


CONCLUSIONS
Although long-term survival was acceptable, postoperative mortality and morbidity rates remained high, confirming the reputation of completion pneumonectomy as a challenging procedure. Significant comorbidities and removal of the right lung were the main risk factors for postoperative mortality. Improved patient selection and better management of preoperative renal failure may improve the postoperative outcomes of this procedure, which offers a chance for prolonged survival.
Chataigner
Olivier
O
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, 133, Avenue de la Resistance, 92350 Le Plessis Robinson, France.
Fadel
Elie
E
Yildizeli
Bedrettin
B
Achir
Abdallah
A
Mussot
Sacha
S
Fabre
Dominique
D
Mercier
Olaf
O
Dartevelle
Philippe G
PG
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008171:Lung Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009765:Obesity / Q000150:complications / Q000401:mortality; D011013:Pneumonectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013995:Time