Pneumonectomy for malignant disease: Factors affecting early morbidity andmortality

Objective: The purpose of this report is to analyze factors affecting morbi dity and mortality after pneumonectomy for malignant disease. Methods: We retrospectively reviewed the cases of all patients who underwen t pneumonectomy for malignancy at the Mayo Clinic. Between January 1, 1985, and September 30, 1998, 639 patients (469 men and 170 women) were identifi ed. Median age was 64 years (range 20 to 86 years). indication for pneumone ctomy was primary lung cancer in 607 (95.0%) patients and metastatic diseas e in 32 (5.0%). Factors affecting morbidity and mortality were analyzed by univariate and multivariate analysis. Results: Cardiopulmonary complications occurred in 245 patients (38.3%; 95% confidence interval 34.6%-42.2%). Factors adversely affecting morbidity wi th univariate analysis included age (P < .0001), male sex (P =.04), associa ted respiratory (P =.02) or cardiovascular disease (P < ,0001), cigarette s moking (P =.02), decreased vital capacity (P =.01), forced expiratory volum e in 1 second (P < .0001), forced vital capacity (P =.002), diffusion capac ity of the lung to carbon monoxide (P =,005), oxygen saturation (P < .05), arterial Po, (P =.007), preoperative radiation (P =.02), bronchial stump re inforcement (P =.007), crystalloid infusion (P =.01), and blood transfusion (P =.02). Factors adversely affecting morbidity with multivariate analysis included age (P =.0001), associated cardiovascular disease (P =.001), and bronchial stump reinforcement (P =.0005). There were 45 deaths (7.0%; 95% c onfidence intervals 5.2%-9.3%). Factors adversely affecting mortality with univariate analysis included associated cardiovascular (P < .0001) or hemat ologic disease (P < .005), lower preoperative serum hemoglobin level (P =.0 04), preoperative chemotherapy (P =.01), decreased diffusion capacity of lu ng to carbon monoxide (P =.002), right pneumonectomy (P =.0006), extended r esection (P =.04), bronchial stump reinforcement (P =.007), and crystalloid infusion (P =.01). Factors affecting mortality with multivariate analysis included hematologic disease (P =.01), lower preoperative serum hemoglobin (P =.003), and completion pneumonectomy (P =.01). Conclusion: Multiple factors adversely affected morbidity and mortality aft er pneumonectomy for malignant disease. Appropriate selection and meticu lo us perioperative care are paramount to minimize risks in those patients who require pneumonectomy.