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Ann Thorac Surg 2007;83:425-432
© 2007 The Society of Thoracic Surgeons
a Division of Thoracic Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
b Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
c VA Medical Center, Boston, and Harvard Medical School, Boston, Massachusetts
d University of Colorado Health Outcomes Program, Denver, Colorado
Accepted for publication September 25, 2006.
* Address correspondence to Dr Linden, Division of Thoracic Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (Email: plinden{at}partners.org).
Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
BACKROUND: Lobectomy is the current standard operation for localized lung cancer. Patients who undergo lobectomy have a 1% to 2% chance per year of developing a second lung cancer. The risks of repeat lung resection have not been well quantified or analyzed. We used a national, prospectively recorded database to evaluate the complication rate and risk factors in this population.
METHODS: The Veterans Affairs National Surgical Quality Improvement Program Database was queried for all patients who underwent lobectomy, followed by an additional lung resection, between 1994 and 2002. Preoperative variables, intraoperative variables, and complications were analyzed. Pulmonary function data were not collected.
RESULTS: Excluding 17 patients who underwent repeat resection for complications of lobectomy, 186 patients underwent 191 repeat resections. The 30-day mortality was 11%; the complication rate was 19%. Mortality for pneumonectomy was 34%, lobectomy, 7%; segmentectomy, 0%; and wedge resection, 6%. The most frequent complications were pneumonia (9%), reintubation (8%), ventilator dependence (6%), cardiac arrest (3%), dysrhythmia (3%), and sepsis (3%). Multivariate analysis revealed that operative time exceeding 2 hours, preoperative dyspnea at rest or with minimal exertion, and white blood cell count of more than 10,000/mm3 were predictors of complication. Presence of a contaminated/infected case, pneumonectomy, and intraoperative transfusion were predictors of death. Age, complications from prior lobectomy, time interval between lobectomy and repeat resection, smoking history, other comorbidities, and preoperative laboratory values were not independent predictors.
CONCLUSIONS: Repeat lung resection after lobectomy carries an 11% overall mortality predicted by the presence of a contaminated/infected case, need for intraoperative transfusion, and pneumonectomy versus a lesser resection.
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