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Vol. 36. Issue 5.
Pages 251-256 (May 2000)
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Vol. 36. Issue 5.
Pages 251-256 (May 2000)
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Morbimortalidad perioperatoria de la neumonectomía. Análisis de los factores de riesgo
Morbidity and mortality during and after pneumonectomy. An analysis of risk factors
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J. López Pujol1, A. Álvarez Kindelán, J. Algar Algar, F. Cerezo Madueño, A. Salvatierra Velázquez
Servicio de Cirugía Torácica. Hospital Regional Universitario Reina Sofía. Córdoba
L. López Rivero*
* Servicio de Cirugía Torácica. Hospital Universitario Insular. Las Palmas
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La neumonectomía sigue siendo una técnica quirúrgica con tasas de morbilidad y mortalidad elevadas.

Objetivo

Determinar la tasa de mortalidad y morbilidad tras neumonectomía y analizar factores de riesgo perioperatorios relacionados con la mortalidad.

Pacientes y métodos

Se han revisado retrospectivamente 266 pacientes sometidos a neumonectomía entre enero de 1986 y diciembre de 1997: 241 casos por carcinoma broncogénico, metástasis pulmonares en 4, bronquiectasias en 9 casos y otra afección benigna en 12 pacientes; el 13% de los casos recibieron terapia neoadyuvante. El muñón bronquial se suturó mecánicamente en el 92% y manualmente en el 8%, y se realizó cobertura del mismo con tejido autólogo en el 73% de los casos. La neumonectomía fue intrapericárdica en el 32%, extendida a pared torácica o diafragma en el 9% y se completó neumonectomía tras resección menor previa en el 3% de los casos. Se recogieron datos demográficos generales, antecedentes patológicos, datos de función respiratoria y técnica quirúrgica. También se obtuvieron datos de mortalidad y complicaciones postoperatorias en los primeros 30 días tras la neumonectomía.

Resultados

Se han realizado 266 neumonectomías, 102 derechas (38%) y 164 izquierdas (62%), en 249 varones (93%) y 17 mujeres (7%), con una media de 58±11 años (rango, 20-79 años). La mortalidad postoperatoria temprana (30 días) fue del 5,6%. La mortalidad fue superior en pacientes mayores de 70 años (p=0,045), diabéticos (p=0,038), sometidos a terapia neoadyuvante (p=0,031), con FEV1 menor de 1.800ml (p= 0,013), en las neumonectomías derechas (p=0,001), extendidas (p=0,037) o sin cobertura del muñón bronquial (p=0,005). Asimismo, la mortalidad fue mayor cuando aparecieron complicaciones del muñón bronquial (p<0,01), complicaciones cardíacas (p<0,001), respiratorias (p<0,001) y digestivas (p=0,002). La morbilidad global fue del 40%. Aparecieron complicaciones quirúrgicas en un 23% de los casos: empiema posneumonectomía (10%), fístula broncopleural (7%) (sin diferencias entre sutura manual y mecánica), hemotórax (3%) y complicaciones de la toracotomía (3%). Doce pacientes se reoperaron (4,5%). La morbilidad cardíaca fue del 20% (fibrilación auricular en el 12%), la morbilidad respiratoria fue del 8% y otras complicaciones aparecieron en el 19% de los casos.

Conclusión

En nuestra experiencia, la mortalidad tras neumonectomía es del 5,6%, con una morbilidad global del 40%, principalmente debida a complicaciones quirúrgicas y cardíacas. La cobertura del muñón bronquial con tejido autólogo reduce el riesgo de muerte postoperatoria por fístula y/o empiema posneumonectomía.

Palabras clave:
Neumonectomía
Morbimortalidad
Factores de riesgo

Pneumonectomy continues to be associated with high rates of morbidity and mortality.

Objective

The aim of this study was to determine the mortality and morbidity rates after pneumonectomy and to analyze perioperative risk factors related to mortality.

Patients and methods

The cases of 266 patients undergoing pneumonectomy between January 1986 and December 1997 were reviewed retrospectively: 241 patients with lung cancer, 4 with pulmonary metastasis, 9 with bronchiectasis and 12 with other benign diseases; 13% received neoadjuvant therapy. The bronchial stump was stapled in 92%, sutured in 8%, and covered with autologous tissue in 73%. Intrapericardial pneumonectomy was performed in 32%, pneumonectomy extended to the chest wall or diaphragm in 9%, and completion pneumonectomy was performed in 3%. We collected general demographic data, medical histories, pulmonary function data and surgical technique. Deaths and postoperative complications within the first 30 days after pneumonectomy were also known.

Results

Two hundred sixty-six pneumonectomies were performed [right 102 (38%); left 164 (62%)] in 249 men (93%) and 17 women (7%) who were 58±11 years of age (20 to 79 years). The rate of early postoperative death (30 days) was 5.6%. Mortality rates were higher among patients over 70 years of age (p=0.045), diabetics (p=0.038), patients undergoing neoadjuvant therapy (p=0.031), those with FEV1 under 1,800ml (p=0.013), cases of right-sided pneumonectomy (p=0.001), cases of extended pneumonectomy (p=0.037) or those without coverage of the bronchial stump (p=0.005). Mortality was also higher when complications appeared involving the bronchial stump (p<0.01), heart (p<0.001), respiration (p<0.001) or digestion (p=0.002). Overall morbidity was 40%. Surgical complications developed in 23%: postpneumonectomy empyema (10%), bronchopleural fistula (7%) (with no significant difference related to stapling or suturing), hemothorax (3%) and wound complications (3%). Twelve patients (4.5%) underwent second operations. Cardiac morbidity was 20% (atrial fibrillation in 12%), respiratory morbidity was 8% and other complications appeared in 19% of cases.

Conclusion

In our experience, mortality after pneumonectomy is 5.6% with an overall complication rate of 40%, mainly due to surgical and cardiac complications. Coverage of the bronchial stump with autologous tissue reduces the risk of postoperative death due to fistula and/or empyema after pneumonectomy.

Key words:
Pneumonectomy
Postoperative mortality
Postoperative complications
Risk factors
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Copyright © 2000. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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