first 2 years of the patients who underwent pneumonectomy
DESCRIPTION
First 2 years of the Patients Who Underwent Pneumonectomy. Akif Turna, Alper Çelikten Adnan 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 - PowerPoint PPT PresentationTRANSCRIPT
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.
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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