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Original Articles: General Thoracic

Surgical Lung Resection for Severe Hemoptysis

^a Respiratory, Tenon Hospital, Assistance Publique - Hôpitaux de Paris and Pierre et Marie Curie University and INSERM U 149, Paris, France
^b Critical Care, Tenon Hospital, Assistance Publique - Hôpitaux de Paris and Pierre et Marie Curie University and INSERM U 149, Paris, France
^c Thoracic Surgery, Tenon Hospital, Assistance Publique - Hôpitaux de Paris and Pierre et Marie Curie University and INSERM U 149, Paris, France
^d Radiology Department, Tenon Hospital, Assistance Publique - Hôpitaux de Paris and Pierre et Marie Curie University and INSERM U 149, Paris, France

Accepted for publication June 4, 2009.

^_* Address correspondence to Dr Fartoukh, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, 04 rue de la Chine, Paris, 75020, France (Email: muriel.fartoukh{at}tnn.aphp.fr).

Background: The role of surgical lung resection in the management of severe hemoptysis has evolved after advances in interventional radiology. We sought to describe the indications for surgical lung resection in such patients and to identify predictive factors of postoperative complications.

Methods: This study is a retrospective analysis (May 1995 to July 2006) of consecutive patients referred to the intensive care unit of a tertiary hospital for severe hemoptysis who underwent surgical lung resection.

Results: Among 813 patients referred for severe hemoptysis, 111 underwent surgical lung resection. Interventional radiology had been first attempted in 87 patients (78%); 68 underwent surgery because of a failed procedure (n = 28) or bleeding persistence or recurrence within 72 hours despite a completed procedure (n = 40); 19 patients underwent surgery after bleeding control. The remaining 24 patients (22%) were directly referred to the surgeon (5 for emergency surgery). Overall, surgery was performed in emergency (n = 48), scheduled after bleeding control (n = 48), or planned after discharge (n = 15). The main indications for surgery were mycetoma, cancer, bronchiectasis, and active tuberculosis. Surgery for mycetoma (odds ratio, 9.4; 95% confidence interval, 2.8 to 32), emergency surgery (odds ratio, 5.3; 95% confidence interval, 1.8 to 16), and pneumonectomy (odds ratio, 4.7; 95% confidence interval, 1.2 to 18) independently predicted complications. Fifteen patients died in the intensive care unit, of whom 14 underwent emergency surgery. Chronic alcoholism (odds ratio, 4.6; 95% confidence interval, 1.1 to 19), the need for mechanical ventilation or vasoactive drugs on admission (odds ratio, 8.2; 95% confidence interval, 1.9 to 35), and blood transfusion before surgery (odds ratio, 8; 95% confidence interval, 1.5 to 42) predicted mortality.

Conclusions: Attempting at controlling bleeding with first-line nonsurgical approaches appears necessary to optimize the operative conditions and improve outcome of patients with severe hemoptysis.

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Invited Commentary

Song Wan and Anthony P.C. Yim
Ann. Thorac. Surg. 2009 88: 1565. [Extract] [Full Text] [PDF]

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				S. Wan and A. P.C. Yim Invited commentary. Ann. Thorac. Surg., November 1, 2009; 88(5): 1565 - 1565. [Full Text] [PDF]