First 2 years of the Patients Who Underwent Pneumonectomy

Akif Turna, Alper ÇeliktenAdnan Sayar,Atilla Gürses

Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Department of Thoracic Surgery, Istanbul

‘Pneumonectomy is a disease’• Approx. 10-15% of all operations

• 20% of operations done for lung cancer

• Regardless of advancements in perioperative care, surgical

mortality and morbidity of pneumonectomy are higher than those

of lobectomy.

• 40—60% of patients face postoperative complications,

cardiovascular complications, bronchopleural fistula, infections,

recurrent laryngeal palsy, delayed extubation and pulmonary

embolus 1--Fuentes PA. Pneumonectomy: historical perspective and prospective insight. Eur J Cardiothorac

Surg 2003;23:439—45.

QuickTime™ and a decompressor

are needed to see this picture.

Ilonen et al., Lung Cancer 2007

Hypothesis Pneumonectomy is known to cause high

morbidity and distress postoperatively. However, little has been known about the

quality of life of these patients who had undergone pneumonectomy after discharge from hospital.

Patients who underwent pneumonectomy may do differently in terms of exercise capacity, well being, pain and working status.

Patients and MethodsPatients and Methods• Study PeriodStudy Period : January 2006 - November 2007: January 2006 - November 2007• PatientsPatients : 100 (95 male 3 female) : 100 (95 male 3 female) • ProceduresProcedures : 50 Pneumonectomy: 50 Pneumonectomy

50 Lobectomy50 Lobectomy• PatolojiPatoloji : 92 malignant: 92 malignant

: 8 benign: 8 benign• All patients were questioned on their daily

activities,exercise capacity, pain, labor status and their affections. Data were analyzed using Chi-square test and McNemar test.

Patients • Mortality

• Pnömonectomy : 5(10%) (4 early, 1 late)• Lobectomy : 2 (4%) (late postoperative period)

• Severe Complication : • Pnömonectomy :5 (%10) (3 bronchopleural fistula)• Lobectomy :2 (%4)• Patients were divided according to time passed after

operation. • Group 1: Procedure performed at least 6 to 12 months

before and Group 2: Pneumonectomy performed at least 13

months before.

Results-Pneumonectomy

• Pain:• Severe : %29.6• Mild : %44.4, • Little : %22.2• No-pain : Yok

• Ability to work: : %7.4

ResultsPneumonectomy

• General Condition• Bad : 22.2%• Mediocre : 40.7%, • Good : 14.8%• Excellent : None

• Ability to perform dailly routines:• Fully capable : %22 • Mediocre : %17.9• Ability to climb 1 stair : %20• Ability to exercise : %7

Results-Pneumonectomy

0

5

10

15

20

25

Daily Exercise Psych. Pain

None

Little

Medium

Good

Great

Lobectomy

0

5

10

15

20

25

Daily Exercise Psych. Pain

None

Little

Medium

Good

Great

* : p=0.01, ** :p=0.03, + : p=0.04

Second Year Outcome in Patients who Underwent Pneumonectomy

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Daily act. Exercise Psych Pain

Lobectomy

Pneumonectomy*

**

+

Results• Time passed after pneumonectomy seemed to

change only mood-status (p=0.05).

• Pneumonectomy induces very significant

deterioration in quality of life in terms of daily

activity, exercise capacity, pain and affection

than those who underwent lobectomy (p=0.03,

0.04, 0.01). Only mood status was found to

recover to some extent.

QuickTime™ and a decompressor

are needed to see this picture.

Brunelli et.al, Ann Thorac Surg., 2007;84:410-416

Discussion

• Pneumonectomy significantly deteriorates normal physiology and force the limits of compensation of human organism.

• It was reported that, pneumonectomy caused mediastinal shift and cardiac rotation leads to decrease in pulmonary function and effort capacity

A. Smulders, Ann Thorac Surg 2007;83:1986-1992

Limitations

No standard ‘quality of life score’ was

utilized. Subjective rather than objective self-repors

were analyzed. Pulmonary function test and arterial gas

analysis were not performed. No long-term analysis (2-5 years) was done.

Discussion•The patients’ perspective about the surgical risk

of lung resection may differ from that of the

surgeons.• What patients fear most is not an increased risk

of perioperative major morbidity or mortality, but

to be left physically and mentally handicapped

and not be able anymore toresume an

acceptable daily lifestyle

•Brunelli, et al.Eur J Cardiothorac Surg 2003;23:439—45.

Conclusions and Future Studies

• Pneumonectomy severely deteriorates quality of life,

affection, exercise capacity and and couses severe

chronic pain in patients undergoing pneumonectomy.

These parameters were significantly worse than those

of patients who underwent lobectomy.• Physicians should be sensitive to these issues.• Minimally invasive methods, more aggressive pain

management and pre and postoperative patient’s

education could improve these patients’ status.

Thank you