Geplante Pneumektomie bei zerstörter Lunge: Leitliniengerechte präoperative Evaluierung durchführen

Abstract

<b>Background:</b> Clinical guidelines recommend a preoperative forced expiratory volume in one second (FEV<sub>1</sub>) of > 2 L as an indication for left or right pneumonectomy. This study compares the safety and long-term prognosis of pneumonectomy for destroyed lung (DL) patients with FEV<sub>1</sub> ≤ 2 L or > 2 L. <b>Methods:</b> A total of 123 DL patients who underwent pneumonectomy between November 2002 and February 2023 at the Department of Thoracic Surgery, Beijing Chest Hospital were included. Patients were sorted into two groups: the FEV<sub>1</sub> > 2 L group (<i>n</i> = 30) or the FEV<sub>1</sub> ≤ 2 L group (<i>n</i> = 96). Clinical characteristics and rates of mortality, complications within 30 days after surgery, long-term mortality, occurrence of residual lung infection/tuberculosis (TB), bronchopleural fistula/empyema, readmission by last follow-up visit, and modified Medical Research Council (mMRC) dyspnea scores were compared between groups. <b>Results:</b> A total of 96.7% (119/123) of patients were successfully discharged, with 75.6% (93/123) in the FEV<sub>1</sub> ≤ 2 L group. As compared to the FEV<sub>1</sub> > 2 L group, the FEV<sub>1</sub> ≤ 2 L group exhibited significantly lower proportions of males, patients with smoking histories, patients with lung cavities as revealed by chest imaging findings, and patients with lower forced vital capacity as a percentage of predicted values (FVC%pred) (<i>P</i> values of 0.001, 0.027, and 0.023, 0.003, respectively). No significant intergroup differences were observed in rates of mortality within 30 days after surgery, incidence of postoperative complications, long-term mortality, occurrence of residual lung infection/TB, bronchopleural fistula/empyema, mMRC ≥ 1 at the last follow-up visit, and postoperative readmission (<i>P</i> > 0.05).