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Vol. 43. Issue 3.
Pages 143-149 (January 2007)
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Vol. 43. Issue 3.
Pages 143-149 (January 2007)
Original Articles
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Risk Factors in Bronchogenic Carcinoma Surger
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José Luis Duquea,
Corresponding author
jduque@hcuv.sacyl.es

Correspondence: Dr. J.L. Duque. Servicio de Cirugía Torácica. Hospital Universitario de Valladolid. Avda. Ramón y Cajal, 3. 47003 Valladolid. España
, Ramon Rami-Portab, Ana Almarazc, Manuel Castanedod, Jorge Freixinete, Antonio Fernández de Rotaf, the Bronchogenic Carcinoma Cooperative Group (GCCB-S) of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) 1
a Servicio de Cirugía Torácica, Hospital Universitario, Valladolid, Spain
b Servicio de Cirugía Torácica, Hospital Mútua de Terrassa, Terrassa, Barcelona, Spain
c Servicio de Medicina Preventiva, Hospital Universitario, Valladolid, Spain
d Servicio de Cirugía Torácica, Hospital Universitario, Valladolid, Spain
e Servicio de Cirugía Torácica, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
f Servicio de Cirugía Torácica, Hospital Carlos Haya, Málaga, Spain
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Objective

To analyze the factors that determine the risk of morbidity and mortality associated with lung resection in patients with bronchogenic carcinoma.

Patients and Methods

Prospective multicenter study conducted between October 1, 1993 and September 30, 1997 in the 19 hospitals that make up the Bronchogenic Carcinoma Cooperative Group. During the study period, 2994 patients with bronchogenic carcinoma underwent surgery. The morbidity and mortality data at 30 days from all centers were recorded in a single registry.

Results

Major resection was performed in 2491 patients, whereas 212 underwent minor resection. The resection had to be extended in 296 and exploratory thoracotomy was carried out in 291.

Postoperative complications were reported in 1057 patients(35.2%). Complications directly related to surgery were the most common (22.9%), followed by respiratory (19.5%) and cardiovascular (10.7%) complications. Of the patients with complications, 654 patients (21.8%) had only 1, whereas 403(13.4%) had more than 1. After classification of complications, 21% were found to be minor and 14.2% were major.

Mortality at 30 days was 6.8% (204 patients), and strongly linked to the presentation of major complications—40.8% of those with such complications died.

Conclusions

Surgical treatment of bronchogenic carcinoma in Spain is associated with high morbidity and mortality. The morbidity reported in the present study lies in the middle of the ranges found in the literature, whereas mortality lies at the high end of the range. The presence of major complications and/or multiple complications should be considered as strong risk factors.

Key words:
Bronchogenic carcinoma
Risk factors
Morbidity
Mortality
Objetivo

Analizar la morbilidad y mortalidad asociadas a la cirugía de exéresis pulmonar por carcinoma broncogénico, como parámetros definitorios del riesgo inherente a este tratamiento.

Pacientes y Métodos

Estudio prospectivo y multicéntrico, realizado en los 19 hospitales integrantes del Grupo Cooperativo de Carcinoma Broncogénico entre el 1 de octubre de 1993 y el 30 de septiembre de 1997. En este tiempo fueron sometidos a toracotomía 2.994 pacientes con carcinoma broncogénico. La morbilidad y mortalidad a los 30 días se recogieron mediante un registro de datos unificado para todos los hospitales.

Resultados

Se practicaron 2.491 exéresis mayores y 212 menores. Se precisó resección extendida en 296 pacientes, mientras que en 291 se efectuó toracotomía exploradora.

En 1.057 pacientes (35,2%) se objetivaron complicaciones postoperatorias, de las que las más frecuentes fueron las relacionadas directamente con la intervención quirúrgica (22,9%), seguidas por las respiratorias (19,5%) y las cardiovasculares (10,7%). En 654 casos (21,8%) las complicaciones fueron de carácter único, mientras que 403 (13,4%) presentaron más de una. Atendiendo a su categoría, el 21% de las complicaciones fueron menores, en tanto que las complicaciones mayores sucedieron en el 14,2% de los casos.

El análisis de la mortalidad en los 30 primeros días mostró una incidencia del 6,8% (204 pacientes), y estuvo notablemente vinculada con la aparición de complicaciones mayores (40,8%).

Conclusiones

En nuestro medio el tratamiento quirúrgico del carcinoma broncogénico genera una morbilidad y una mortalidad elevadas, en el rango de las habitualmente referidas en relación con la morbilidad y en el límite alto cuando se considera la mortalidad. La presencia de complicaciones mayores y/o su multiplicidad deben considerarse elementos sustancialmente moduladores del incremento del riesgo.

Palabras clave:
Carcinoma broncogénico
Parámetros de riesgo
Morbilidad
Mortalidad
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The coordinators and members of the GCCB-S are listed at the end of the article.

This study was partially funded by the grants FIS97/0011 and FEPAR-1995. Additional financial support was provided by the government (Junta) of the autonomous community of Castile-Leon and the Menarini Foundation.

Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología

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