Evaluation of factors affecting morbidity and mortality in pneumonectomy patients.

BACKGROUND: The aim of this study was to evaluate risk factors associated with morbidity and mortality after pneumonectomy in non-small cell lung cancer patients. METHODS: The study included 107 patients who underwent pneumonectomy for non-small cell lung cancer between January 2013 and December 2018. Prognostic factors affecting mortality and morbidity were investigated. RESULTS: The patient group included 10 women (9.3%) and 97 men (90.7%) with a mean age of 59.5 ± 8.5 years. Seventy-three patients (68.2%) underwent standard pneumonectomy and 34 (31.8%) underwent extended pneumonectomy. Nine patients (8.4%) received induction chemotherapy. Complications occurred in 33 patients (30.8%). Complications were classified as surgical, cardiovascular, pulmonary, or infectious. Charlson Comorbidity Index (CCI) > 3 and right-side resection were significant risk factors for the development of complications. The most common complication was atrial fibrillation. Eleven patients developed a bronchopleural fistula. The 30-day postoperative mortality rate was 6.5% (n = 7). Mortality was not associated with any demographic and surgical characteristics other than CCI > 3 (p = .05). CONCLUSION: The results of this study indicate that our pneumonectomy outcomes are acceptable despite high morbidity and mortality rates. Appropriate patient selection for pneumonectomy is as important as complication management. High-comorbidity patients should undergo these procedures in experienced centers.

Unexpected conversion to thoracotomy during thoracoscopic lobectomy: a single-center analysis.

BACKGROUND: The aim of this study was to discuss indications and outcomes for conversion to thoracotomy during thoracoscopic lobectomy. MATERIALS AND METHODS: Patients who underwent lobectomy for non-small cell lung cancer between January 2012 and December 2016 were evaluated retrospectively. The study included 129 patients who underwent video-assisted thoracoscopic lobectomy (group-V) and 18 patients converted from thoracoscopic lobectomy to thoracotomy due to unexpected intraoperative complications (group-T). RESULTS: The two patient groups showed no statistical differences in terms of demographic characteristics. Causes of unexpected conversions to thoracotomy were hemorrhage in six patients, dense pleural adhesions in seven patients, fused fissure in one patient, and fibrocalcified lymph nodes around the vascular structures in four patients. Operative time was 180.37 ± 68.6 min in group-V and 235 ± 72.6 min in group-T (p = 0.003). Intraoperative blood loss was 263.9 ± 180.6 mL in group-V, compared to 562.7 ± 296.2 mL in group-T (p < 0.001). Patient age ≥ 70 years was a significant risk factor for conversion to thoracotomy (p = 0.015, odds ratio 4.73). The 5-year survival rate in group-V was 71.4% {mean: 65.2 months [95% confidence interval (CI) 59.6-70.8]}, while that in group-T was 80% [mean 54.9 months (95% CI 45.9-63.8)] (p = 0.548). CONCLUSION: Advanced age was identified as the main risk factor for conversion to thoracotomy. However, early- and long-term outcomes were similar in the two groups, indicating that video-assisted thoracoscopic surgery is a safe and applicable method.