Nov 24, 2003 - by bronchopleural fistula and empyema (26.66%), cardiac. (20%) and post operative hemorrhage (6.6%) (Table 3). Introduction. Lung cancer is ...
174 Ahanger et al Bronchogenic carcinoma
IJTCVS 2003; 19: 174–177
Early operative mortality after surgical treatment of bronchogenic carcinoma AG Ahanger, M.Ch., S Shabir, MS, AM Dar, M.Ch., GN Lone, M.Ch., MA Bhatt, M.Ch., A Mir, M.Ch., RA Wani, MS Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir Abstract Background : A retrospective analysis of the results of pulmonary resection over a 7 years period for bronchogenic carcinoma was performed. Methods: Three hundred and eleven patients with primary bronchogenic carcinoma were operated upon at Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, between January 1996 to June 2002. There were 62 pneumonectomies (19.93%), 174 lobectomies (55.94%) and 75 lesser resections (24.11%). Results: The overall operative mortality was 4.82%. The mortality rate for pneumonectomy, lobectomy and lesser resections were 9.6%, 4.5% and 1.3% respectively. There was no significant difference in operative mortality between pneumonectomy and lobectomy, and between lobectomy and lesser resections. Post operative mortality rate increased as the age of patient increased. Mortality was 2.3;2.9;5.0;7.41; and 14.2 in the age groups of 70 Reference No. 4. 9. 5. 6. 10. 11. 12. 8
Year 1983 1987 1988 1991 1991 1994 1994 1997 Present Study 2003 Jan 1996 – June 2002
No
Mortality (%)
No
Mortality (%)
1979-1981 1977-1984 1970-1985 1980-1987 1983-1985 1981-1991 1974-1991 1994
453 64 71 81 94 2330
7.1 9.4 11.2 4.9 17.0 2.1
37 40 33 225
8.1 15.0 3.0 2.2
54
7.41
7
14.29
years old. Lung cancer study group (LCSG) in 19834 reported mortality of 7.1% in age group =70 years and 8.1% for age group of =80 years old. Sherman et al12, Deneffe et al5 and Whittle et al13 reported mortality of 9.4%, 11.2% and 17.0% respectively in age group of =70 years old. Naunheim et al14 and Osaki et al15 reported mortality of 15.0% and 3% in age groups of =80 years old. Japanese Association for chest Surgery published mortality of 2.1% in age group of =70 years and 2.2% in age group of =80 years old8. Bernet et al16 reported overall operative mortality of 2.2% and 2.6% after pneumonectomy in patients younger than 50 years. In patients older than 70 years of age, operative mortality was 2.5% and 3.8% after pneumonectomy and concluded that advanced age did not affect operative mortality. Causes of death were respiratory failure and pneumonia in 46.66% of patients followed by bronchopleural fistula (26.6%), cardiac (20%) and postoperative bleeding (6.6%). Lung cancer study group (LCSG) also reported respiratory failure as the commonest cause of death followed by bronchopleural fistula with empyema4. Whereas Japanese Association for chest surgery reported pneumonia and respiratory
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Age >80
Years Analysed
failure commonest cause of death (51.61%), followed by cardiac (15.0%)8. Duque et al9 reported respiratory failure as a cause of early operative mortality in 67.5%. The possible reasons of decreased mortality in lung resections for lung cancer in the recent literature could be related to early diagnosis and therapy, resulting from the wide use of computed tomography and other diagnostic modalities; improvements in operative technique, anaesthesia, circulartory and respiratory management and control of post operative infections. References 1. Weiss W. Operative mortality and 5 year survival rates in men with bronchogenic carcinoma. Chest 1974; 66: 483–87. 2. Vincent RG, Takila H, Lone WW, Gutierrez AC, Pickren JW. Surgical therapy of lung cancer. J Thorac Cardiovasc Surg 1976; 71: 581–91. 3. Cook JW, Robicsek F, Daugherty HK, Selle JG, Sanger PW, Scott WP. The late results of surgical treatment of lung cancer. NC Med J 1978; 39: 541–45. 4. Ginsberg RJ, Hill LD, Eagan RT, et al. Modern thirty-day operative mortality for surgical resections in lung cancer. J Thorac Cardiovasc Surg 1983; 86: 654–58.
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IJTCVS 2003; 19: 174–177
Ahanger et al 177 Bronchogenic carcinoma
5. Deneffe G, Lacquet LM, Verbeken E , Vermaut G. Surgical treatment of bronchogenic carcinoma: a retrospective. Study of 720 thoracotomies. Ann thorac Surg 1988; 45: 380–83. 6. Kadri MA, Dussek JE, Survival and prognosis following resection of primary nonsmall cell bronchogenic carcinoma. Eur J Cardiothorac Surg 1991; 51: 132–36. 7. Romano PS, Mark DH. Patient and hospital characteristics related to in-hospital mortality after lung cancer resections. Chest 1992; 101: 1332–37. 8. Wada H, Nakamura T, Nakamoto K, Maeda M, Watanabe Y. Thirty day operative nortality for thoracotomy in lung cancer. J Thorac Cardiovasc Surg 1997; 115: 70–73. 9. Duque JL, Ramos G, Castrodeza J, Castanedo M, Yuste MG, Heras F. Early complications in surgical treatment of lung cancer: a prospective multicenter study. Ann Thorac Surg 1997; 63(4): 944– 50. 10. Bernard A, Deschamps C, Allen MS, Miller DL, Trastek VF, Jenkins GD, Pairolero PC. Pneumonectomy for malignant disease: Factors affecting early morbidity and mortality. J Thorac Cardiovasc Surg 2001; 12(6): 1076–82.
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11. Licker M, Spiliopoulas A, Frey JG, Robert J, Hohn L, Deperrots M, Tschopp JM. Risk factors for early mortality and major complications following pneumonectomy for non-small cell carcinoma of the lung. Chest 2002; 121(6): 1890–97. 12. Sherman S, Guidot CE. The feasibility of thoracotomy for lung cancer in the elderly. JAMA, 1987; 258: 927–30. 13. Whittle J, Steinberg EP, Andersen GF, Herbert R. Use of Medicare claims data to evaluate outcomes in elderly patients undergoing the resection for lung cancer. Chest 1991:100; 729–34. 14. Naunheim KS, Kesler KA, D’orazio SA, Fiore AC, Judd DR. Lung cancer surgery in the octogenarian. Eur J cardiothorac Surg 1994; 8: 453–56. 15. Osaki T, Shirakusa T, Kodate M, Nakanishi R, Mitsudomi T, Ueda H. Surgical treatment of lung cancer in the octogenarian. Ann Thorac Surg 1994; 57: 188–93. 16. Bernet F, Brodbeck R, Guenin MO, Schupfer G, Habicht JM, Stulz PM, Carrel TP. Age does not influence early and late tumorrelated outcome for bronchogenic carcinoma. Ann Thorac Surg 2000; 69(3): 678-79.
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