Elective pneumonectomy for benign lung disease: Modern-day mortality and morbidity

Abstract

This retrospective study of elective pneumonectomy for complicated inflammatory lung disease was done to define modern-day mortality and morbidity. One hundred twenty-four patients received elective pneumonectomy. Patient ages ranged from 6 months to 71 years. Past, recurrent, or new pulmonary tuberculosis was present in 107 patients (86.3%). Clinical presentation involved recurrent infections or severe suppurative sequelae (abscess, empyema). Forty-seven patients had chronic hemoptysis and 25 patients had past or recent massive hemoptysis (> 600 ml of hemoptysis fluid within 24 hours). Nutritional deficiencies were common. One hundred six patients (85.5%) had end-stage destroyed lungs. Evaluative bronchoscopy showed inflammatory endobronchial changes in 106 patients (85.5%), bronchial strictures in 4, and indolent endobronchial tumor in 2. Lung separation was by double-lumen tube in 96 patients, single lung-single tube in 6, bronchus blocker in 6, and prone posture in 9. Extrapleural pneumonectomy was done in 83 patients (66.9%). Fifty-seven of these procedures were left sided and 26 were right sided. Standard transpleural pneumonectomy was done in 41 patients (33.1%): 30 left sided and 11 right sided. Nine pneumonectomies were conducted with the patient in the prone position. Four patients had completion pneumonectomy. Hospital mortality was three deaths (2.4%). Morbidity included postpneumonectomy empyema in 19 patients (15.3%). Seven postoperative bronchopleural fistulas occurred. Empyema in most patients was managed by open pleural drainage (thoracostoma) and later space closure. Pneumonectomy proved effective therapy with low mortality but postpneumonectomy empyema posed serious morbidity.

Pneumonectomy in destroyed lung cases

“…Bu olgularda ciddi komplikasyonların en hızlı ve etkili tedavisinin pnömonektomi olduğu kanıtlanmış-tır. 4,6,7 Çalışmamızda kronik öksürük, ateş, medikal tedaviye rağmen tekrarlayan enfeksiyonlar, pürülan balgam çıkarma, solunum sıkıntısı ve masif hemoptizi nedeniyle olgulara pnömonektomi uygulandı.…”

“…Böylece çevre lenf nodlarının büyümesi ile obstruksiyona eğilim daha fazladır. 7 Çalışmamızda da 10 olgudan 8'inde sol akciğerde patoloji tespit edildi.…”

Analysis of Pneumonectomy for Benign Disease: A Single Institution Retrospective Study on 59 Patients

“…TB is the leading cause of pneumonectomy for benign disease. 3,4) In the current series, TB accounted for 81.4% of all the patients. This data was compatible with most reports.…”

“…From then on, pneumonectomy had become the only curative treatment for some benign diseases such as complication of tuberculosis, cystic bronchiectasis, suppurative lung disease, invasive opportunistic infection in immunocompromised patients, massive pulmonary trauma, hemoptysis, Casetleman's disease, rare congenital abnormalities and so on. [2][3][4] In spite of the development of the devices and skills of the operation, pneumonectomy for benign lung disease is still a challenging procedure. Because of the dense scar tissue and inflammation surrounding major vascular, the fused pleural surface and the medical comorbidities, the morbidity of the patients with benign lung disease after pneumonectomy was almost three times higher than that for lung cancer patients.…”

“…[5][6][7] However, some surgeons advocate that pneumonectomy for benign disease can be performed with acceptable morbidity and mortality. 3,4,8) We retrospectively evaluated the patients who underwent pneumonectomy, pleuropneumonectomy and completion pneumonectomy for treating benign disease to show the factors influencing the outcomes.…”