Comparison of the Results of Parenchymal Sparing Operation and Pneumonectomy for Non-small Cell Lung Cancer

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 2004, 30 pneumonectomies and 30 parenchymal sparing procedures 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 and 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. CONCLUSION: We suggested that as a curative treatment, parenchymal sparing operation may be a safer procedure than pneumonectomy without adversely affecting outcome. Pneumonectomy can be avoided in a large proportion of patients with non-small cell lung cancer

Bridging Bronchus in Adult / 대한흉부외과학회지

Bridging bronchus (BB) is an extremely rare tracheobronchial anomaly. This anomaly is often associated with a sling left pulmonary artery (SLPA) and is diagnosed in infancy or at autopsy. A 29-year-old female patient with previous history of pulmonary tuberculosis was admitted because of persistent fever, cough and sputum. Fiberoptic bronchoscope and chest computed tomography revealed a bridging bronchus and associated atelectasis. The right middle and lower lobe was supplied by a bronchus which originates from the left main bronchus and bridges the mediastinum. There was no anomaly of a left pulmonary artery. Right middle and lower bilobectomy was performed.

Incidence and Risk Factors of Postpneumonectomy Pulmonary Edema with Non-Small Cell Lung Cancer: A Retrospective Analysis

PURPOSE: To evaluate the incidence of postpneumonectomy pulmonary edema (PPE) and determine the risk factors for PPE with non-small cell lung caner. MATERIALS AND METHODS: A group of 93 patients who underwent a pneumonectomy between 1994 and 2004 were retrospectively studied. Postpneumonectomy patients with pulmonary edema, with no clinically evident cause, with the exception of having undergone a pneumonectomy, were considered to have PPE. The incidence and mortality of PPE were recorded. The preoperative, perioperative and postoperative clinical data were reviewed, and the patients matched for known or suspected risk factors for PPE. A logistic regression analysis and Chi-square test were used to evaluate the relationships of the risk factors to the PPE. RESULTS: The incidence of PPE was 7.5% (n=7). The mortality in the group of patients who developed PPE was 86% (n=6). Patients who had fresh frozen plasma administered had a significantly higher incidence of PPE (risk ratio=14.9, p=0.024). CONCLUSION: Fresh frozen plasma (FFP) transfusion after a pneumonectomy was shown to be an important risk factor in our data. The mechanism has not been identified, but may be an increased capillary permeability of the pulmonary vessels due to an immunologic reaction following a FFP transfusion