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Abstract
Purpose:
Parenchymal sparing lung surgery indicated for central tumors for which the alternative is pneumonectomy. Pneumonectomy has a higher perioperative mortality risk than lobectomy. To increase resection rates and improve outcomes we have implemented a policy of parenchymal sparing operation for tumors involving a main stem bronchus and pulmonary artery.
Materials and Methods:
From January 2000 to May 2004ô30 pneumonectomies and 30 parenchymal sparing proced䴸res were carried out in the Department of Thoracic and Cardiovascular Surgery of Ajou University Hospital. Suvival and complications were analyzed and compared. Parenchymal sparing operation was always done when technically possible. Thus pneumonectomy was reserved for lesions that could not be removed by a parenchymal sparing operation.
Results:
There were no significant inter-group differences in perioperative course or outcome and patient characteristics except postoperative stage. One year survival was 56.7% after pneumonectomy arid 86,7% after parenchymal sparing operation. The rate of pneumonectomy decreased significantly with increasing experience of parenchymal sparing operation with 21 of the last 32 patients (66%) avoiding pneumonectomy.
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Table 1.
Demographic Characteristics
Table 2.
Broncho plastic Procedures Performed
| No. of patients (%) | |
|---|---|
| Left upper lobe | 6 (20) |
| Left lower lobe | 6 (20) |
| Right upper lobe | 11 (37) |
| Upper bilobectomy | 2 (6.5) |
| Lower bilobectomy | 3 (10) |
| Right lower lobe | 2 (6.5) |
| Total | 30 (100) |
Table 3.
Postoperative Complications for both Procedures
| Pneumonectomy | Sleeve resection | |
|---|---|---|
| Mortality | 3 | 0 |
| Pneumonia | 4 | 1 |
| Atelectasis | 0 | 7 |
| Arrhythmia | 1 | 3 |
| BPF | 1 | 1 |
| Prolonged air leak | 0 | 2 |
| Chylothorax | 1 | 1 |
| ARDS (PRE) | 3 | 0 |
Table 4.
Annual Cases
| Year | Pneumonectomv | Sleeve resection |
|---|---|---|
| 2000 | 10 | 2 |
| 2001 | 9 | 7 |
| 2002 | 1 | 5 |
| 2003 | 6 | 10 |
| 2004 | 4 | 6 |
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