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Sekundäre Pneumonektomien

Indikationen und Langzeitergebnisse

Completion pneumonectomy

Indications and results

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Zusammenfassung

Die sekundäre Pneumonektomie (SP) ist anerkanntermaßen mit einer hohen Morbidität und Letalität verbunden. Sie stellt allerdings häufig die einzige Möglichkeit der Heilung dar. Die Ergebnisse folgender SP (n=86) wurden untersucht: Progression oder Rezidiv einer gutartigen Erkrankung (n=6, Gruppe I), Rezidiv eines Malignoms (n=41, Gruppe II) und Komplikation nach Lungenresektion (n=39, Gruppe III). 48 SPs wurden rechtsseitig, 38 linksseitig durchgeführt.

Die gesamte 30-Tages-Letalität betrug 20,2% (in Gruppe I 0%, in Gruppe II 10%, in Gruppe III 33,3%). Die 30-Tages-Letalität war nach SP rechts (29,8%) signifikant höher als nach SP links (7,7%; p=0,014). Die SP in notfallmäßiger Indikation (54%) war mit einer signifikant höheren 30-Tages-Letalität als in dringlicher Indikation (23%; p=0,002) assoziiert. Bei Vorhandensein einer Stumpf- oder Anastomoseninsuffizienz betrug die 30-Tages-Letalität 41% (p=0,002). Die 5-Jahres-Überlebensrate der Patienten mit Rezidiv eines Malignoms betrug 26%, die der Patienten mit Komplikation nach Lungenresektion 32%.

Diese Ergebnisse zeigen: die Letalität der SP ist hoch, in Anbetracht des Langzeitüberlebens ist sie allerdings gerechtfertigt.

Abstract

Completion pneumonectomy (CP) is widely known to be associated with high morbidity and lethality. However, in certain instances, it offers the only chance for cure. The results of the following CPs (N=86) were investigated: progressive or recurrent benign disease (N=6, group I), recurrence of a malignant tumor (N=41, group II), and complication after lung resection (N=39, group III). Right completion pneumonectomy was carried out in 48 cases and left completion pneumonectomy in 38.

The overall 30-day lethality of CP was 20.2%, 0% in group I, 10% n group II, and 33.3% n group III. This lethality was significantly higher on the right side (29.8%) than on the left (7.7%; P=0.014). Differentiation between emergency and urgent indications resulted in 30-day lethalities of 54% and 23%, respectively. This difference is significant (P=0.002). The 30-day lethality for patients with anastomotic or stump insufficiency was 41% (P=0.002). Five-year survival was 26% in the group of patients with malignant disease and 32% in those with complications after lung resection.

The results show: the lethality of CP remains high, especially after complications from operating in emergency conditions. However, considering the long-term survival, CP is certainly justified.

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Authors and Affiliations

  1. Abteilung für Thoraxchirurgie, Universitätsklinik Freiburg

    W. Jungraithmayr, J. Hasse & E. Stoelben

  2. Abteilung für Medizinische Biometrie and Statistik, Universität Freiburg

    M. Olschewski

  3. Abteilung für Thoraxchirurgie, Universitätsklinik Freiburg, Hugstetter Straße 55, 79106 , Freiburg

    W. Jungraithmayr

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  1. W. Jungraithmayr
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  2. J. Hasse
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  3. M. Olschewski
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  4. E. Stoelben
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Correspondence to W. Jungraithmayr.

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Jungraithmayr, W., Hasse, J., Olschewski, M. et al. Sekundäre Pneumonektomien. Chirurg 76, 157–166 (2005). https://doi.org/10.1007/s00104-004-0905-x

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  • DOI: https://doi.org/10.1007/s00104-004-0905-x

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