Frequency and mortality of acute lung injury and acute respiratory distress syndrome after pulmonary resection for bronchogenic carcinoma

Objective: We reviewed the frequency and mortality of acute lung injury (AL I) and acute respiratory distress syndrome (ARDS) in our population of pati ents submitted to pulmonary resection for primary bronchogenic carcinoma. M ethods: From January 1993 to December 1999, a total of 1221 patients receiv ed pulmonary resection for primary bronchogenic carcinoma. Of thc sz. 27 me t the criteria of post-operative ALI/ARDS. There were 24 men and three wome n with a mean age of 64 years (range 45-79). Preoperatively, predicted mean of PaO2, PaCO2 and %FEV1 were 72 mmHg (57-86), 37 mmHg (33-42) and 80% (37 -114), respectively. Associated cardiac risk factors were present in eight patients. Three patients (11%)had pre-operative radiotherapy. Surgical-path ologic staging included 14 patients at Stage I, 8 patients at Stage II. fou r patients at Stage IIIa and one patient at Stage IIIb. Results: ALI/ARDS o ccurred in 2.2% of our operated lung cancer patients. ALI was diagnosed in 10 patients and ARDS in 17 patients. The mean time of presentation followin g surgery was 4 days (range 1-10) and 6 days (1-13) for ALI and ARDS, respe ctively. According to the type of operation, the frequency was highest foll owing right pneumonectomy (4.5%), followed by sublobar resection (3.2%), le ft pneumonectomy (3%), bilobectomy (2.4%), and lobectomy (2%). The frequenc y following extended operations was 4%. No differences were found between t he ALI/ARDS group and the total population of resected lung cancer patients (control group) with respect to sex, mean age, pre-operative blood gases, %FEV1, surgical-pathologic staging and the use of pre-operative radiotherap y. Four patients with ALI (40%) and 10 patients with ARDS (59%) died, Morta lity was highest following right pneumonectomy, extended operations and sub lobar resections. Hospital mortality of the total population of operated lu ng cancer patients in the same period was 2.8% (34 patients). ALI/ARDS acco unted for 41% of our hospital mortality. Conclusions: (I) ALV ARDS is a sev ere complication following resection for primary bronchogenic carcinoma. (2 ) We did not detect any significant difference between the ALI/ARDS group a nd the control group regarding age, pre-operative lung function, staging an d pre-operative radiotherapy. (3) ALI/ARDS is associated with high mortalit y, the highest mortality rates having been observed following right pneumon ectomy and extended operation; it currently represents our leading cause of death following pulmonary resection for lung carcinoma. (4) ALI/ARDS may a lso occur after sublobar resections with an associated high mortality rate. (C) 2001 Elsevier Science B.V. All rights reserved.