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Früh- und Spätergebnisse nach Pneumonektomie und Manschettenlobektomie nicht kleinzelliger Bronchialkarzinome im Stadium I–IIIa

Comparison of morbidity, 30-day mortality and long-term survival after pneumonectomy and sleeve lobectomy for NSCLC

  • ORIGINALARBEIT
  • Published:
Zeitschrift für Herz-, Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Fragestellung:

Ziel dieser Arbeit ist es, Morbidität, Mortalität und das Langzeitüberleben nach einer Manschettenlobektomie oder einer Pneumonektomie zu vergleichen. Die Vorteile einer Manschettenlobektomie als Alternative zu einer Pneumonektomie, im Hinblick auf die Erhaltung der Lungenfunktion, zu zeigen. Zu klären ist, ob die Radikalität erhalten bleibt.

Patienten und Methode:

Retrospektive Analyse der Daten von 310 Patienten, operiert zwischen 1987 bis 1997 an einem nicht kleinzelligen Bronchialkarzinom, Stadium I bis IIIa. Bei 194 Patienten erfolgte eine Pneumonektomie, bei 116 Patienten eine Manschettenlobektomie. Analysiert wurden die operationsspezifischen Komplikationen, die Morbidität, die 30-Tage-Mortalität und das 5-Jahres-Überleben (5JÜLR). Die Nachsorge ist vollständig für 96% der 310 Patienten über 5 Jahre.

Ergebnisse:

Nach Manschettenlobektomie trat eine Insuffizienz der Anastomose bei 6,9% (8/116) der Patienten auf und die Mortalität betrug 4,3%. Die Bronchusstumpfinsuffizienz nach Pneumonektomie wurde bei 7/194 Patienten diagnostiziert (3,6%). Die Mortalität lag bei 4,5%. Die Resektion war R0 bei 98% der Patienten. Die 5JÜLR beträgt nach Pneumonektomie 27%, nach einer Manschettenlobektomie liegt sie bei 39%. Prognostisch günstig für das 5JÜLR ist das Alter, der Lymphknotenstatus, das Tumorstadium und die Operationstechnik.

Diskussion:

Die Indikation zu einer Pneumonektomie oder Manschettenlobektomie wird durch die Lokalisation des Tumors bestimmt—dieser ist meist weiter fortgeschritten in der Pneumonektomiegruppe—und anhand der Herz- und Lungenfunktion—diese ist öfters eingeschränkt in der Manschettenresektionsgruppe. Insofern erklärt sich die fast identische 30-Tage-Mortalität der beiden Gruppen. Das Langzeitüberleben belegt ein Überlebensvorteil für die Manschettenresektion, des Alter <65 Jahren, des pN0-Status und Stadium I.

Summary

Objective:

The aim of this retrospective, non-randomized study was to compare early and late outcome of these procedures. The equivalence of the radicality in resection of non-small cell lung cancer has been questioned for sleeve lobectomy. However, most reports show a higher operative risk for pneumonectomy.

Method:

The charts of 310 patients who underwent either pneumonectomy or sleeve lobectomy for lung cancer stage I to stage IIIa from 1987–1997 were reviewed. A total of 194 patients underwent pneumonectomy and 116 patients underwent sleeve lobectomy. Specific operative complications, i. e. anastomotic leakage versus stump dehiscence, perioperative complications, and 30-day- or in-hospital mortality were registered for comparison of the immediate risk of the respective procedures. The 5-year follow-up is complete in 291 patients (96%). The follow-up data were analyzed for the comparison of oncologic adequacy.

Results:

In the group of bronchial sleeve lobectomy (SL) the incidence of anastomotic leakage was 6.9% (8/116) and the operative mortality was 4.3%. The incidence of bronchial stump fistula after pneumonectomy was 3.6% (7/194), and the early mortality was 4.6%. All but 6 patients (98%) had complete resection. The 5-year survival after sleeve lobectomy was 39% and after pneumonectomy 27%. Multivariate analysis of the data demonstrated that age <65, sleeve lobectomy, pN0 and stage I are prognostically favorable factors.

Conclusion:

The indication for pneumonectomy vs. sleeve lobectomy depends on the localization of the primary tumor which is usually more advanced in the pneumonectomy group, on the one hand, and on cardio-respiratory function which is often distinctly impaired in the sleeve group, on the other hand. This might explain why the mortality in the group of sleeve lobectomy was identical with that in the pneumonectomy group. However, it is shown that both techniques are appropriate modalities of treatment in the case of more advanced cancer and/or critical functional reserve, respectively.

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Authors and Affiliations

  1. Abteilung Thoraxchirurgie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79104, Freiburg, Germany

    C. Ludwig,  J. Hasse &  E. Stoelben

  2. Abteilung Medizinische Biometrie und Statistik, Stefan-Meier-Str. 26, 79104, Freiburg, Germany

    M. Olschewski

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  1. C. Ludwig
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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 C. Ludwig.

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Ludwig, C., Hasse, J., Olschewski, M. et al. Früh- und Spätergebnisse nach Pneumonektomie und Manschettenlobektomie nicht kleinzelliger Bronchialkarzinome im Stadium I–IIIa. Z Herz-, Thorax-, Gefäßchir 18, 268–274 (2004). https://doi.org/10.1007/s00398-004-0466-9

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