Original article
General thoracic
Risk of a Right Pneumonectomy: Role of Bronchopleural Fistula

https://doi.org/10.1016/j.athoracsur.2004.07.009Get rights and content

Background

The purpose of this study is to compare the morbidity and mortality of right versus left pneumonectomy.

Methods

We used a retrospective review of pneumonectomies performed during the period 1990 to 2000 and included a meta-analysis of relevant literature.

Results

There were 187 pneumonectomies: 68 right, 119 left. The primary study end point was in-hospital death. There were 11 deaths: 7 (10.3%) right, 4 (3.3%) left (p = 0.10). Six deaths were attributable to bronchopleural fistula and its subsequent complications. The risk of bronchopleural fistula was higher on the right (9 [13.2%]) versus left (6 [5.0%]; p = 0.0472), as was the mortality associated with bronchopleural fistula (4 of 9 [44%] right versus 2 of 6 [33%] left). Right pneumonectomies were more likely to require an intrapericardial or extended dissection (p = 0.003), hand-sewn bronchial closure (p < 0.0001), or the closure buttressed (p < 0.0001). By univariate analysis, factors associated with an increased mortality were bronchopleural fistula (p < 0.0001), hand-sewn closure (p = 0.001), and a history of smoking (p = 0.01). By multivariate analysis, the most important factor was bronchopleural fistula (odds ratio, 43.3; 95% confidence limits, 4.2 to 441.9; p = 0.002). A meta-analysis combining our results with those from the literature found increased mortality of right pneumonectomy with a relative risk of 3.39 (95% confidence limits, 2.10 to 5.48; p < 0.00001).

Conclusions

Right pneumonectomy is associated with a higher mortality even in the absence of induction therapy. This is primarily related to the increased risk of bronchopleural fistula on the right. The increased number of bronchopleural fistulas on the right may be attributable to more extensive resection. Addressing technical factors that contribute to early bronchopleural fistula may reduce the mortality of right pneumonectomy.

Section snippets

Material and Methods

A retrospective analysis was conducted of 187 patients who underwent pneumonectomy between 1990 and 2000 in the Division of Thoracic Surgery at the Toronto General Hospital, University Health Network, and Mount Sinai Hospital. One hundred eighty patients underwent operation for primary carcinoma of the lung, 5 for metastatic disease, 1 for aspergilloma, and 1 for tuberculous disease. Patients having extrapleural pneumonectomy for mesothelioma or carinal or completion pneumonectomy were excluded

Results

There were 187 patients; 68% (128) were male. The mean age was 67.1 ± 11.5 years (range, 19 to 92 years). Right pneumonectomy (R) was performed in 68 (36%) and left pneumonectomy (L), in 119 (64%). The indication for surgery was primary bronchogenic carcinoma in 180 patients (including carcinoid tumors), metastatic cancer in 5, and septic lung disease in 2 (one each for aspergilloma and tuberculosis). Squamous cell cancer was the most common primary lung cancer histologic assessment, occurring

Comment

The mortality of pulmonary resection has diminished during the years, with current mortality rates for pneumonectomy reported in the range of 5% to 12% 6, 7, 9, 10, 11, 12, 13, 14, 15. However, there are little data in the literature regarding the risk of a right versus left pneumonectomy. Wahi and associates [6], in a series of 197 patients, were the first to report that a right pneumonectomy was associated with a higher mortality (12%) than left (1%), with an overall mortality of 7%. Au and

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  • Cited by (0)

    *Dr Ginsberg died on March 1, 2003.

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