التفاصيل البيبلوغرافية
| العنوان: |
Bilobectomy for lung cancer: contemporary national early morbidity and mortality outcomes. |
| المؤلفون: |
Thomas, Pascal A., Falcoz, Pierre-Emmanuel, Bernard, Alain, Pimpec-Barthes, Françoise Le, Jougon, Jacques, Brouchet, Laurent, Massard, Gilbert, Dahan, Marcel, Loundou, Anderson |
| المصدر: |
European Journal of Cardio-Thoracic Surgery; Feb2016, Vol. 49 Issue 2, pe38-e43, 6p, 2 Charts |
| مصطلحات موضوعية: |
LUNG cancer, BILOBECTOMY, MORTALITY, PNEUMONECTOMY, BODY mass index, BRONCHIAL fistula |
| مستخلص: |
OBJECTIVES: To determine contemporary early outcomes associated with bilobectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database. METHODS: A total of 1831 patients, who underwent elective bilobectomy for primary lung cancer between 1 January 2004 and 31 December 2013, were selected. Logistic regression analysis was performed on variables for major adverse events. RESULTS: There were 670 upper and 1161 lower bilobectomies. Video-assisted thoracic surgery was seldom performed (2%). Induction therapy and extended resection were performed in 293 (16%) and 279 patients (15.2%), respectively. Operative mortality was 4.8% (upper: 4.5%/lower: 5%; P = 0.62), and significantly higher following extended procedures when compared with standard bilobectomy (4.3 vs 7.5%; P = 0.013). Pulmonary complication rate was 21.1%. Bronchial fistula occurred in 46 patients (2.5%) and pleural space complications in 296 (16.2%). Their respective incidence rates were significantly higher following lower than upper bilobectomy (3.5 vs 0.7%; P < 0.001 and 17.8 vs 13.3%; P = 0.007). At multivariate analysis, extended procedures [odds ratio (OR), 2.3; 95% confidence interval (CI), 1.03–5.31; P = 0.04], ASA scores of 3 or greater (OR, 2.02; 95% CI, 1.33–3.07; P < 0.001) and World Health Organization performance status 2 or greater (OR, 1.47; 95% CI, 1.01–2.13; P = 0.04) were risk predictors of mortality. Female gender (OR, 0.39; 95% CI, 0.19–0.80; P = 0.01), highest body mass index (BMI) values (OR, 0.91; 95% CI, 0.86–0.96; P = 0.001) and recent years of surgery (OR, 0.91; 95% CI, 0.84–0.99; P = 0.02) were protective. Predictors of bronchial fistula were male gender, lowest BMI values, lower bilobectomy and longest operative times. Male gender, lowest BMI values and longest operative times were also predictors of pulmonary complications, together with highest ASA scores and lowest forced expiratory volume in 1 s values. CONCLUSIONS: Risks related to lower bilobectomy lie halfway between those reported for lobectomy and pneumonectomy. Additional surgical measures to prevent pleural space complications and bronchial fistula should be encouraged with this operation. In contrast, upper bilobectomy shares more or less the same hazards as lobectomy. [ABSTRACT FROM AUTHOR] |
|
Copyright of European Journal of Cardio-Thoracic Surgery is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
Full Text Finder