Real surgical morbidity and mortality after extrapleural pneumonectomy
Wednesday, October 31st, 2007.
Chirurgia Italiana. 2007 Jul-Aug;59(4):453-60. [Link]
Pagan V, Fontana P, Zaccaria A, Lo Giudice F, Ferronato A, Salvi R, Lovadina S.
Thoracic Surgery Unit, Umberto I General Hospital, Venezia-Mestre.
Abstract
As for other major thoracic operations the conventional 30-day morbidity and mortality marker may underestimate the actual surgical risk of extrapleural pneumonectomy. We retrospectively analysed the prolonged follow-up of 78 patients submitted to extrapleural pneumonectomy for pleural mesothelioma (55), lung cancer with associated carcinomatous (7) or purulent (8) pleuritis, empyema/destroyed lung (4), and mediastinal (2) and chest wall (2) tumours with pleuro-pulmonary involvement. Significant rates of surgery-related major complications (19%) and fatalities (6.6%) additionally occurred beyond 30 days and within 6 months of extrapleural pneumonectomy, making a 66% cumulative (early + late) morbidity rate and an 11.5% cumulative mortality rate, which are respectively 50% and 100% greater than the 30-day rate alone. The leading causes of late morbidity and mortality were respiratory/cardiac sequelae (50%) and broncho-pleural fistulas (30%). Strict preoperative functional selection and proper application of the technical learning curve can reduce the occurrence of the adverse events by anything up to 50% (early mortality: 2.3%). If the results of this novel study of long-term surgical outcomes of extrapleural pneumonectomy were to be confirmed, the preoperative risk/benefit balance of the procedure, mainly when performed for thoracic malignancies, should therefore include the entire spectrum of (early and late) potential surgery-related complications.
Glossary
- morbidity
- a measure of the new cases of a disease in a population; the number of people who have a disease.
- mortality
- a measure of the rate of death from a disease within a given population.
- cancer
- malignancy; a group of diseases typified by abnormal, generally out-of-control, cell growth.
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
- extrapleural pneumonectomy
- (EPP) surgery to remove the pleura, diaphragm, pericardium, and entire lung involved with the tumor. You can view a web cast from Brigham and Women's Hospital in Boston of this procedure being done by Dr. David Sugarbaker: see the extrapleural pneumonectomy (EPP) web cast here.
