Respiratory Infections After Lung Cancer Resection

Abstract

The progress that has been made in patient selection, minimally invasive surgery, anesthesia (both in surgery and in the control of postoperative pain), and antibiotic treatments have substantially improved the morbility and mortality associated with the surgical treatment of bronchogenic carcinoma in recent years. Nevertheless, the rate of major complications after lung cancer resection is 2% to 22%, and the mortality rate is 2% to 7%. The most frequent complications after lung cancer resection are of respiratory origin. The most serious ones are pneumonia and acute respiratory distress syndrome, and they are also the main causes of death in this period. They also share similar clinical and evolutionary features that can make it difficult to distinguish between them. The incidence of pneumonia after a lung cancer resection is 2% to 20%, and the mortality in patients that develop pneumonia is significantly higher than in other patients. It is also the cause of death in 22% to 67% of cases after lung resection. Therefore, patients with lung cancer treated with lung resection comprise a population with a high risk of experiencing pneumonia with a serious prognosis. Apart from being one of the main factors that determine short-term survival, postoperative pneumonia prolongs the hospital stay and involves a significant consumption of resources (antibiotics, stay in intensive care unit). For all these reasons, there is growing interest in identifying the factors associated with the risk, prevention, diagnosis, and treatment of respiratory infections after lung cancer resection.Key Words: lung cancer resection, postoperative pneumonia, risk factors (Clin Pulm Med 2006;13: 8 -16) B ronchogenic carcinoma is the most frequent neoplasia (900,000 new cases in men and 330,000 in women per year) and the first cause of death from cancer in the world in both men and women. 1 The overall probability of being alive 5 years after the diagnosis is 15%, a percentage that has barely changed in the last 35 years. 2 This is the result of, among other reasons, diagnosis in the advanced stages of the disease (less than 30% of cases are diagnosed in stages I and II, when the disease is limited and surgical resection offers a probability of survival at 5 years of 70% and 40%, respectively). Early diagnosis is therefore decisive to take advantage of surgical treatment, which is the option that currently offers the greatest probability of a cure to the greatest number of patients (Table 1).The advances made in anesthesia and minimally invasive surgery have allowed surgical indications to be extended to those patients who are at greater risk of experiencing complications or dying after a lung resection. Moreover, multidisciplinary treatments of bronchogenic carcinoma have led to more pneumonectomies, with a subsequent increase in the morbidity and mortality associated with resection. Reducing the complications and mortality associated with the surgical treatment of bronchogenic carcinoma is another important aspect if the potential benefit...

A Pilot Study of the Incidence of Post-thoracotomy Pulmonary Complications and the Effectiveness of Pre-thoracotomy Physiotherapy Patient Education

“…3,8,22 In this study, the no preop group was found to have significantly higher rates of abnormal leukocyte counts; however, given the lack of difference in radiographic findings and fever, this difference may be related to other complications, such as wound infection.…”

“…[7][8][9][10] These large differences in reported incidences can be attributed to a number of differences in study characteristics, including the nature of the population, the degree of lung resection, antibiotic prophylaxis, defining criteria for PPC, and postoperative management (including pain control). 18 Atelectasis was the most frequent complication detectable via radiography.…”

“…1,2,6,8,21 In this population, epidural infusion was the choice of analgesia for all patients in both groups. No statistically significant between-group difference was detected in the number of days of postoperative analgesia used; however, there was no standardized method of assessing or documenting pain as a problem from the patient's perspective.…”

“…1 Other frequently observed post-surgical complications are post-thoracotomy pain syndrome and ipsilateral reductions in upper-extremity range of motion (ROM) and strength. 1,[6][7][8] These problems, while not of a respiratory nature, can indirectly influence pulmonary status via their impact on the ability to move, breathe, and cough, leading to ineffective management and clearing of secretions. 1,6,7 The incidence of PPC following thoracotomy has been reported to be anywhere between 2% and 75% in the literature.…”

“…1,6,7 The incidence of PPC following thoracotomy has been reported to be anywhere between 2% and 75% in the literature. [7][8][9][10] Acute-care physiotherapists perform a variety of functions in the care of patients undergoing surgery, from the preoperative period up until postoperative discharge. 7 Vital to this patient population is the prevention and resolution of PPC, wherein lies a distinct role for physiotherapists.…”