Chest
Volume 105, Issue 3, March 1994, Pages 760-766
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Clinical Investigations: Lung Cancer
Pulmonary Complications in Patients Undergoing Thoracotomy for Lung Carcinoma

https://doi.org/10.1378/chest.105.3.760Get rights and content

One hundred three consecutive patients undergoing 106 thoracotomies for primary lung carcinoma were reviewed to determine factors associated with the development of postoperative pulmonary complications. Pulmonary complications occurred in 40 of 104 (39 percent) patients. Minor complications occurred in 17 of 104 (16 percent) patients and major in 23 of 104 (22 percent). There were six deaths in the entire series of 103 patients (6 percent), two of which were directly caused by a pulmonary complication and one where it was a contributing factor. Extended surgical resections were associated with an increased risk of complications. Pulmonary complications occurred in 9 of 11 (82 percent) patients undergoing extended resections involving chest wall resection. The use of neoadjuvant chemotherapy also was associated with an increase in the rate of major complications. Poor nutritional status as measured by a history of weight loss and preoperative serum albumin levels also was associated with an increased risk of any pulmonary complication. Cardiac complications were significantly increased in the group of patients having pulmonary complications. Pulmonary complications continue to present a major source of morbidity and mortality for patients undergoing thoracotomy for lung carcinoma. Determination of factors associated with increased risk is important in order to identify patients who might be predisposed to the development of these complications.

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MATERIALS AND METHODS

One hundred three patients underwent 106 thoracotomies for primary lung cancer between February 1990 and September 1991 at Roswell Park Cancer Institute. (Three patients had staged thoracotomies for synchronous bilateral primaries.) Charts of these patients were retrospectively reviewed.

All patients had histologically proven lung carcinoma except one. This patient had a clinically diagnosed Pancoast tumor and received preoperative radiation. No carcinoma was found in the resected specimen,

RESULTS

One hundred six thoracotomies were performed, including 29 pneumonectomies, 57 lobectomies, 8 segmentectomies, 4 wedge resections, and 8 biopsies. Extended resections were performed in 25 patients. Included were 11 chest wall resections performed in combination with pulmonary resections (2 with pneumonectomy, 2 with lobectomy, and 1 with wedge resection) and 14 other extended resections. Three patients had staged bilateral thoracotomies for synchronous primary tumors. Two of these underwent

DISCUSSION

Pulmonary complications are a major cause of morbidity and mortality following thoracotomy in patients with lung cancer, as evidenced by the 39 percent pulmonary complication rate in this series. The overall mortality rate of 6 percent compares with the rate of 3.7 percent reported by Ginsberg et al23 in a recent large cooperative series of 2,200 patients undergoing resections for lung carcinoma.

Previous series have reported between 50 and 70 percent of deaths to be directly related to a

ACKNOWLEDGMENT

We wish to thank Dr. Leslie Blumenson for his contribution to the statistical analysis.

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Supported in part by Research grant CA 16056 awarded by the National Cancer Institute.

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