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J Thorac Cardiovasc Surg 2000;120:119-127
© 2000 The American Association for Thoracic Surgery

GENERAL THORACIC SURGERY

Bronchoplastic procedures in malignant and nonmalignant diseaseMultivariable analysis of 144 cases

From the Department of Cardiothoracic Surgery,^a University of Vienna; the Department of Thoracic Surgery,^b Center of Pulmology; and the Institute of Medical Statistics,^c University of Vienna, Vienna, Austria.

Address for reprints: Adelheid End, MD, Department of Cardiothoracic Surgery, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria (E-mail: adelheid.end{at}univie.ac.at ).

Objectives: We sought to analyze the experience with bronchoplastic procedures over a 7-year period and to determine putative prognostic factors for survival.
Methods: From 1991 to 1997, 144 bronchoplastic procedures were performed for non–small cell lung cancer (n = 123), small cell lung cancer (n = 5), carcinoid tumor (n = 10), and metastases of extrathoracic malignant tumors (n = 6). There were 111 sleeve lobectomies, 17 bilobectomies, 4 lobectomies with carinal resection, 8 sleeve pneumonectomies, and 4 bronchotomies without parenchymal resection. Multivariable analysis included risk factors, such as age, sex, type of bronchoplastic procedure (bronchotomy, lobectomy, bilobectomy, or pneumonectomy), additional angioplasty, TNM staging, histology, radicality of resection, respiratory risk (forced expiratory volume in 1 second, percent predicted < 60), cardiovascular risk, and adjuvant therapy.
Results: Overall 1- and 3-year survival was 72% and 52%, respectively. The overall 30-day mortality was 8.3% (5.4% for single sleeve lobectomies). Multivariable analysis demonstrated 4 risk factors for survival. High tumor stage, type of bronchoplastic procedure, impaired lung function, and presence of cardiovascular risk were associated with a poor outcome. Univariate analysis showed reduced survival in patients with sleeve pneumonectomies (1-year survival, 25%).
Conclusions: Bronchoplastic procedures for central tumors and sleeve pneumonectomies are associated with poor survival. Careful selection of these patients, as well as of patients with impaired lung function and cardiovascular risk factors, is mandatory.

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