Portal de Periódicos da CAPES

Morbidity, mortality, and survival after bronchoplastic procedures for lung cancer

1997; Oxford University Press; Volume: 11; Issue: 2 Linguagem: Inglês

10.1016/s1010-7940(96)01023-8

1873-734X

Federico Rea,

Pleural and Pulmonary Diseases

OBJECTIVE: Bronchoplastic procedures represent an effective surgicaltherapy for benign lesions, tumors of low-grade malignancy and alsobronchogenic carcinoma in patients with a limited pulmonary function. Weanalyzed our experience in order to verify the mortality, morbidity, andlong term survival in our patients. METHODS: From 1980 to 1994, 217patients underwent bronchoplastic procedures. We performed 92bronchoplasties, 94 bronchial sleeves, and 31 tracheo-bronchial sleeves.Histologic examination revealed 133 epidermoid carcinomas, 28adenocarcinomas, 11 small cells lung cancers, 5 large cells carcinomas, 2adenosquamous carcinomas, 29 bronchial carcinoids, 6 adenoidocisticcarcinomas, and 3 mucoepidermoid tumors. Regarding nodal status, 99patients had N0 disease, 64 patients had N1 disease, and 54 patients had N2disease. Thirty-six patients had preoperative irradiation and 181 patientshad no preoperative irradiation. In 63 patients we used a perianastomoticpedicled flap; in 154 we did not use it. We considered all the 217 patientsfor the analysis of 30-day mortality and morbidity; of the 217 patients weanalyzed long-term survival only in 179 because we excluded 38 patientswith low grade malignant neoplasm. RESULTS: Twenty-seven patients (12.5%)had postoperative complications. The 30-day mortality was 6.2% (14patients). Survival at 5 and 10 years for all patients but those with lowgrade malignant neoplasm was 49 and 38%, respectively. For patients with N0status 5- and 10-year survival was 72.4 and 59.4%; for patients with N1status these rates were 35.7 and 26.8%; for patients with N2 status, 5- and10-year survival was 22 and 14.4%. Postoperative complication rates forpatients with or without pedicled flap are not significantly different;however, the rates for patients with or without preoperative irradiationare significantly different. CONCLUSIONS: Bronchoplastic procedures are asafe and effective therapy for selected patients with pulmonary malignancy.Tracheo-bronchial sleeves are associated with high postoperative mortalityand complication rates and these procedures should be limited to patientswithout N2 disease. Preoperative irradiation increases significantly themortality and morbidity. A multivariate analysis shows that only the nodalstatus affects long- term survival (P = 0.0002).