Bronchoplastic procedures in malignant and nonmalignant disease: Multivariable analysis of 144 cases

Objectives: We sought to analyze the experience with bronchoplastic procedu res over a 7-year period and to determine putative prognostic factors for s urvival. Methods: From 1991 to 1997, 144 bronchoplastic procedures were performed fo r non-small cell lung cancer (n = 123), small cell lung cancer (n = 5), car cinoid tumor (n = 10), and metastases of extrathoracic malignant tumors (n = 6). There were 111 sleeve lobectomies, 17 bilobectomies, 4 lobectomies wi th carinal resection, 8 sleeve pneumonectomies, and 4 bronchotomies without parenchymal resection. Multivariable analysis included risk factors, such as age, sex, type of bronchoplastic procedure (bronchotomy, lobectomy, bilo bectomy, or pneumonectomy), additional angioplasty, TNM staging, histology, radicality of resection, respiratory risk (forced expiratory volume in 1 s econd, percent predicted < 60), cardiovascular risk, and adjuvant therapy. Results: Overall 1- and 3-year survival was 72% and 52%, respectively. The overall 30-day mortality was 8.3% (5.4% for single sleeve lobectomies). Mul tivariable analysis demonstrated 4 risk factors for survival. High tumor st age, type of bronchoplastic procedure, impaired lung function, and presence of cardiovascular risk were associated with a poor outcome. Univariate ana lysis showed reduced survival in patients with sleeve pneumonectomies (1-ye ar survival, 25%). Conclusions: Bronchoplastic procedures for central tumors and sleeve pneumo nectomies are associated with poor survival. Careful selection of these pat ients, as well as of patients with impaired lung function and cardiovascula r risk factors, is mandatory.