Original article
General thoracic
Morbidity of Lung Resection After Prior Lobectomy: Results from the Veterans Affairs National Surgical Quality Improvement Program

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
https://doi.org/10.1016/j.athoracsur.2006.09.081Get rights and content

Backround

Lobectomy is the current standard operation for localized lung cancer. Patients who undergo lobectomy have a 1% to 2% chance per year of developing a second lung cancer. The risks of repeat lung resection have not been well quantified or analyzed. We used a national, prospectively recorded database to evaluate the complication rate and risk factors in this population.

Methods

The Veterans Affairs National Surgical Quality Improvement Program Database was queried for all patients who underwent lobectomy, followed by an additional lung resection, between 1994 and 2002. Preoperative variables, intraoperative variables, and complications were analyzed. Pulmonary function data were not collected.

Results

Excluding 17 patients who underwent repeat resection for complications of lobectomy, 186 patients underwent 191 repeat resections. The 30-day mortality was 11%; the complication rate was 19%. Mortality for pneumonectomy was 34%, lobectomy, 7%; segmentectomy, 0%; and wedge resection, 6%. The most frequent complications were pneumonia (9%), reintubation (8%), ventilator dependence (6%), cardiac arrest (3%), dysrhythmia (3%), and sepsis (3%). Multivariate analysis revealed that operative time exceeding 2 hours, preoperative dyspnea at rest or with minimal exertion, and white blood cell count of more than 10,000/mm3 were predictors of complication. Presence of a contaminated/infected case, pneumonectomy, and intraoperative transfusion were predictors of death. Age, complications from prior lobectomy, time interval between lobectomy and repeat resection, smoking history, other comorbidities, and preoperative laboratory values were not independent predictors.

Conclusions

Repeat lung resection after lobectomy carries an 11% overall mortality predicted by the presence of a contaminated/infected case, need for intraoperative transfusion, and pneumonectomy versus a lesser resection.

Section snippets

Patients and Methods

The VA NSQIP methods have been detailed in prior publications [8, 9]. The preoperative, intraoperative, and perioperative variables that are collected can be viewed in prior publications [10]. Institutional Review Board approval for this study was obtained at VA Boston Healthcare System; the need for patient consent was waived.

Patient Demographics and Diagnoses

Average age was 66 years (range, 33 to 87 years) at the time of the second operation, 185 (97%) were men, 163 (85%) were white, and 20 (10%) were African American. The median time interval between lobectomy and repeat resection was 13 months (range, 2 days to 83 months). Of the 191 repeat resections, 164 (86%) were for lung or bronchus malignancy, 15 (8%) were for other neoplasms, and the remaining 12 (6%) were for benign disease. Preoperative comorbidities are listed in Table 1.

Initial Operation

Of the original

Comment

Several recent retrospective series have examined the results of repeat lung resection, mainly from the standpoint of long-term survival. Deschamps and colleagues [11] reported on the surgical treatment of 80 multiple lung cancers. Patients were treated with a variety of initial and repeat operations including pneumonectomy, lobectomy, and lesser resections. Complications occurred in 38%, and the perioperative mortality was 5% [11]. A 1991 report by Rosengart and colleagues [12] examined 107

References (19)

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