Effect of complications on survival after lung cancer surgery

Yıl 2021, Cilt: 46 Sayı: 4, 1588 - 1595, 30.12.2021

Osman Yakşi , Ali Kılıçgün , Ezel Ersen , İsmail Sarbay , Mehmet Ünal , Akif Turna , Kamil Kaynak

https://doi.org/10.17826/cumj.980951

Cited By: 1

Öz

Purpose: This study aims to investigate the effect of complications on survival after lung cancer surgery.
Materials and Methods: This is a retrospective study of 802 patients who underwent surgical operations for lung cancer at two centers between January 2002 and December 2019. All patients were retrospectively evaluated according to age, gender, cancer stage, surgical technique, biochemical tests, pulmonary function tests, pulmonary risk index, length of the hospital stay, and the existing number of complications.
Results: In total, 802 patients (%84 males, %16 females) with a mean age of 60 years (range 19-88 years) were included in the study. 5-year overall survival rate was 62.3%. 224 complications occurred in 180 patients (22.4%). The ten most common complications, respectively, were prolonged air leak (54), pneumonia (22), arrhythmia (19), respiratory failure (15), hemorrhage (17), atelectasis (10), pneumothorax-expansion defect (7), arrest (7) bronchopleural fistula (7), subileus-ileus (6). Cancer stage, the existing number of complications, advancing age, and tumor size are parameters that significantly affect survival. The occurs of one or more complications significantly adversely affects survival.
Conclusion: Although the morbidity and mortality of lung cancer surgery have decreased in recent years, it is still high. Advanced stage lung cancer, advancing age, enlargement of tumor size and occurs of complications that negatively affect survival. Careful preoperative preparation may play a role in increasing long-term survival, as well as preventing complications, and decreasing early mortality.

Anahtar Kelimeler

Lung Cancer, Postoperative, Surgery, Complications

Akciğer kanseri ameliyatı sonrası gelişen komplikasyonların sağkalıma etkisi

Öz

Amaç: Bu çalışma ile akciğer kanseri ameliyatı sonrası komplikasyon gelişiminin sağ kalıma etkisini araştırmayı amaçladık.
Gereç ve Yöntem: Ocak 2002-Aralık 2019 tarihleri arasında iki merkezde operasyon uygulanan 802 akciğer kanserli olgular geriye dönük incelendi. Hastalarda, yaş, cinsiyet, kanser evresi, ameliyat tekniği, biyokimyasal değerleri, solunum fonksiyon testleri, pulmoner risk indeksi, postoperatif yatış süreleri ve gelişen komplikasyonlar analiz edildi.
Bulgular: 802 hastanın %84 ü erkek, %16 sı kadındı. Ortalama yaş 60 (19-88yaş) idi. Genel sağkalım 5 yıllık % 62,3 idi. 180 hastada (%22.4) 224 komplikasyon gelişti. En sık görülen on komplikasyon uzamış hava kaçağı (54), pnömoni (22), aritmi (19), solunum yetmezliği (15), hemoraji (17), atelektazi (10), pnömotoraks-expansiyon kusuru (7), arrest (7), bronkoplevral fistül(7), subileus-ileus(6) olarak sıralandı. Kanser evresi, komplikasyon gelişimi, ileri yaş ve tümör çapı anlamlı olarak sağ kalımı etkileyen parametrelerdir. Bir ve/veya birden fazla komplikasyon gelişmesi sağ kalımı önemli derecede kötü etkilemektedir.
Sonuç: Akciğer kanseri cerrahisinin morbidite ve mortalitesi son yıllarda azalmakla birlikte hala yüksektir. İleri akciğer kanseri evresi, yaşın ilerlemesi, tümör çapının büyümesi ve komplikasyon gelişmesi sağkalımı olumsuz etkilemektedir. Preoperatif dikkatli hazırlık, komplikasyon gelişmesini önlemek, erken dönem mortaliteyi azaltması yanında, uzun dönemde sağkalımı artırıcı rol oynayabilir.

Anahtar Kelimeler

Akciğer kanseri, Ameliyat sonrası, Cerrahi, komplikasyonlar

Kaynakça

• 1. Kozower BD. Complications of Thoracic Surgical Procedures. In: Locicero III J, Feins RH, Colson YL, Rocco G eds. General Thoracic Surgery. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 2019:1211-35.
• 2. Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon JE, Landreneau RJ, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 2006;81(3):1013–19.
• 3. Salati M, Refai M, Pompili C, Xiume F, Sabbatini A, Brunelli A. Major morbidity after lung resection: a comparison between the European Society of Thoracic Surgeons Database system and the Thoracic Morbidity and Mortality system . J Thorac Dis. 2013;5(3):217-22.
• 4. Ernest G. Chan, Patrick G. Chan, Matthew J. Results of Surgical Treatment of Non-Small Cell Lung Cancer .In: Locicero III J, Feins RH, Colson YL, Rocco G, eds. General Thoracıc Surgery 8th ed. Philadelphia: Lippincott Williams and Wilkins; 2019:2572-73.
• 5. Rueth NM, Parsons HM, Haberman EB, Groth SS, Virnig BA, Tuttle TM, et al. Surgical treatment of lung cancer: predicting postoperative morbidity in the elderly population. J Thorac Cardiovasc Surg 2012;143(6):1314-23.
• 6. Karmakar MK, Ho AM. Postthoracotomy pain syndrome. Thorac Surg Clin 2004;14(3):345-52.
• 7. Yakşi E, Yakşi O. Current treatment options for post-thoracotomy pain syndrome: a review. Curr Thorac Surg 2017;2(3):103-10.
• 8. Thorpe A, Rodrigues J, Kavanagh J, Batchelor T, Lyen S. Postoperative complications of pulmonary resection. Clin Radiol. 2020;75(11):876.e1-876.e15.
• 9. Koehler RP, Kenan RJ. Management of postthoracotomy pain: acute and chronic. Thorac Surg Clin 2006;16:287-97.
• 10. Haithcock BE, Feins RH . Complications of Pulmonary Resection. In: Shields TW, Locicero III J, Reed CE, Feins RH, eds. General Thoracic Surgery. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2009:551-59.
• 11.Varela G, Jimenez MF, Novoa N, Aranda JL. Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg 2005;27:329-33.
• 12. Sirbu H, Busch T, Aleksic I, Lotfi S, Ruschewski W, Dalichau H. Chest re-exploration for complications after lung surgery. Thorac Cardiovasc Surg 1999;47(2):73-6.
• 13. Erdogu V, Akin H, Sonmezoglu Y, Kutluk AC, Sezen CB, Dogru MV, Saydam O, Metin M. Comparison of the Video-assisted Thoracoscopic Lobectomy versus Open Thoracotomy for Primary Non-Small Cell Lung Cancer: Single Cohort Study with 269 Cases. Sisli Etfal Hastan Tip Bul. 2020 Sep 4;54(3):291-296.
• 14. Locicero J, Alex GL, editors. Arrhythmias seen after cardiac and thoracic operations. Complications, avoidance and treatment in cardiothoracic surgery. Blackwell Publishing; 2011. p. 54-73.
• 15. Tarkka M, Pokela R, Lepojarvi M, Nissinen J, Kärkölä P. Infection prophylaxis in pulmonary sur¬gery: a randomized prospective study. Ann Tho¬rac Surg 1987;44(5):508-13.
• 16. Schussler O, Alifano M, Dermine H, Strano S, Casetta A, Sepulveda S, et al. Postoperative pneu¬monia after major lung resection. Am J Respir Crit Care Med 2006;173(10):1161-9.
• 17. Bernard AC, Deschamps C, Allen MS, Miller DL, Trastek VF, Jenkins GD, et al. Pneumonectomy for malignant disease: factors affecting early mor¬bidity and mortality. J Thorac Cardiovasc Surg 2001;121(6):1076-82.
• 18. Sok M, Dragas AZ, Erzen J, Jerman J. Sources of pathogens causing pleuropulmonary infections after lung cancer resection. Eur J Cardiothorac Surg 2002;22(1):23-7.
• 19. Rueth NM, Parsons HM, Haberman EB, Groth SS, Virnig BA, Tuttle TM, et al. The long-term impact of surgical complications after resection of stage I nonsmall cell lung cancer: a population-based survival analysis. Ann Surg 2011;254:368-74.
• 20. Fernandez FG, Kosinski AS, Furnary AP, Onaitis M, Kim S, Habib RH et al. Differential effects of operative complications on survival after surgery for primary lung cancer. J Thorac Cardiovasc Surg 2018;155(3):1254-64.
• 21. Thomas PA, Falcoz PE, Bernard A, Pimpec BF, Jougon J, Brouchet L, et al. Bilobectomy for lung cancer: contemporary national early morbidity and mortality outcomes. Eur J Cardiothorac Surg 2016 Feb;49(2):e38-43.