First 2 years of the patients who underwent pneumonectomy
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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

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First 2 years of the Patients Who Underwent Pneumonectomy

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First 2 years of the patients who underwent pneumonectomy

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

‘Pneumonectomy is a disease’

  • Approx. 10-15% of all operations

  • 20% of operations done for lung cancer

  • Regardless ofadvancements in perioperative care, surgical mortality and morbidity of pneumonectomy are higher than those of lobectomy.

  • 40—60% of patientsface 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.


First 2 years of the patients who underwent pneumonectomy

Ilonen et al., Lung Cancer 2007


Hypothesis

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 methods

Patients and Methods

  • Study Period: January 2006 - November 2007

  • Patients : 100 (95 male 3 female)

  • Procedures: 50 Pneumonectomy

    50 Lobectomy

  • Patoloji: 92 malignant

    : 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

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

Results-Pneumonectomy

  • Pain:

    • Severe: %29.6

    • Mild: %44.4,

    • Little: %22.2

    • No-pain: Yok

  • Ability to work:: %7.4


Results pneumonectomy1

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 pneumonectomy2

Results-Pneumonectomy


Lobectomy

Lobectomy


First 2 years of the patients who underwent pneumonectomy

+

**

*

*: p=0.01, **:p=0.03, +: p=0.04


Results

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.


First 2 years of the patients who underwent pneumonectomy

Brunelli et.al, Ann Thorac Surg., 2007;84:410-416


Discussion

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

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.


Discussion1

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

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

Thank you


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