Ahmet ÜÇVET, Soner GÜRSOY, Özgür SAMANCILAR, Serkan YAZGAN

Completion pneumonectomy: Indications and outcomes in non-small cell lung cancer

Background: This retrospective single-center study aims to review theindications and outcomes of completion pneumonectomy after primaryresection due to non-small cell lung cancer.Methods: Of a total of 452 patients who underwent pneumonectomybetween January 2004 and August 2017 for non-small cell lung cancer,29 (24 males, 5 females; mean age 59.9±7.1 years; range, 45 to 72 years)were performed completion pneumonectomy. Patients’ indications,factors affecting early and late-term outcomes, operative mortality andsurvival rates were analyzed.Results: Operative mortality rate was 24.1%, including two intraoperativeand five postoperative deaths. Complication rate was 44.8% and the mostfrequent complication was bronchopleural fistula with 24.1%. Studypopulation was divided into two groups. While elective completionpneumonectomy group (n=19) consisted of recurrent malignant tumorpatients, rescue completion pneumonectomy group (n=10) consisted ofpatients performed urgent pneumonectomy due to a bronchopulmonarycomplication developing after an anatomic lung resection. The morbidityand mortality rates for elective completion pneumonectomy and rescuecompletion pneumonectomy were 26.3% and 21.1%; and 70% and 30%,respectively. The morbidity for rescue completion pneumonectomy wassignificantly higher than elective completion pneumonectomy (p=0.016).Advanced age and presence of any preoperative risk (comorbidityand neoadjuvant treatment) were related to higher operative mortality(p=0.019 and p=0.049, respectively). The median survival aftercompletion pneumonectomy was 19.5 months (95% confidence interval17.2 to 21.9 months).Conclusion: The morbidity and mortality rates of completionpneumonectomy are higher than standard pneumonectomy. Rescuecompletion pneumonectomy is related to higher postoperative risk, buthas better survival. The most significant complication after completionpneumonectomy is bronchopleural fistula. Advanced age and presenceof any preoperative risk are related to statistically significantly highermortality in completion pneumonectomy. Nevertheless, completionpneumonectomy is still a significant treatment option in selectedpatients.

Tamamlayıcı pnömonektomi: Küçük hücreli dışı akciğer kanserinde endikasyon ve sonuçlar

Amaç: Bu retrospektif, tek merkezli çalışmada, küçük hücreli dışı akciğer kanseri için primer rezeksiyondan sonra yapılan tamamlayıcı pnömonektominin endikasyonları ve sonuçları incelendi. Çalışma planı: Küçük hücreli dışı akciğer kanseri nedeniyle Ocak 2004-Ağustos 2017 tarihleri arasında pnömonektomi geçiren toplam 452 hastanın 29’una (24 erkek, 5 kadın; ort. yaş 59.9±7.1 yıl; dağılım, 45-72 yıl) tamamlayıcı pnömonektomi uygulandı. Hastaların endikasyonları, erken ve geç dönem sonuçlarını etkileyen faktörler, ameliyat mortalitesi ve sağkalım oranları analiz edildi. Bulgular: Ameliyat mortalitesi oranı %24.1 idi ve bu oran iki ameliyat sırası ve beş ameliyat sonrası ölümü içeriyor idi. Komplikasyon oranı %44.8 idi ve en sık komplikasyon %24.1 ile bronkoplevral fistül idi. Çalışma popülasyonu iki gruba ayrıldı. Elektif tamamlayıcı pnömonektomi grubu (n=19) rekürren malign tümör hastalarından oluşur iken kurtarma tamamlayıcı pnömonektomi (n=10) grubu anatomik bir akciğer rezeksiyonundan sonra gelişen bronkopulmoner bir komplikasyon nedeni ile acil pnömonektomi uygulanan hastalardan oluştu. Elektif tamamlayıcı pnömonektomi ve kurtarma tamamlayıcı pnömonektomi için morbidite ve mortalite oranları sırasıyla %26.3 ve %21.1; %70 ve %30 idi. Kurtarma tamamlayıcı pnömonektomi için morbidite elektif tamamlayıcı pnömonektomiden anlamlı biçimde daha yüksek idi (p=0.016). İleri yaş ve ameliyat öncesi risk bulunması (komorbidite ve neoadjuvan tedavi) daha yüksek ameliyat mortalitesi ile ilişkili idi (sırasıyla, p=0.019 ve p=0.049). Tamamlayıcı pnömonektomiden sonra ortalama sağkalım 19.5 ay idi (%95 güven aralığı 17.2-21.9 ay). Sonuç: Tamamlayıcı pnömonektominin morbidite ve mortalite oranları standart pnömonektomiden daha yüksektir. Kurtarma tamamlayıcı pnömonektomi daha yüksek ameliyat sonrası risk ile ilişkilidir fakat daha iyi sağkalıma sahiptir. Tamamlayıcı pnömonektomiden sonra en önemli komplikasyon bronkoplevral fistüldür. Tamamlayıcı pnömonektomide ileri yaş ve ameliyat öncesi risk varlığı, istatistiksel olarak anlamlı şekilde daha yüksek mortalite ile ilişkilidir. Bununla birlikte, tamamlayıcı pnömonektomi seçilmiş hastalarda hala önemli bir tedavi seçeneğidir.

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