Morbidity and mortality in a large series of surgical patients with pulmonary metastases of colorectal carcinoma: A prospective multicentre spanish study (GECMP-CCR-SEPAR)

Rodríguez-Fuster, A. ; Belda-sanchis, J. ; Aguiló, R. ; Embun, R. ; Mojal, S. ; Call, S. ; Molins, L. ; De andrés, J. J. R. (Universidad de Zaragoza) ; on behalf of GECMP-CCR-SEPAR

Resumen: OBJECTIVE: Little information is available on postoperative morbidity and mortality after pulmonary metastasectomy. We describe the postoperative morbidity and mortality in a large multicentre series of patients after a first surgical procedure for pulmonary metastases of colorectal carcinoma (CRC) and identify the pre- and intraoperative variables influencing the clinical outcome.
METHODS: A prospective, observational and multicentre study was conducted. Data were collected from March 2008 to February 2010. Patients were grouped into Groups A and B according to the presence or absence of postoperative complications. Variables in both groups were compared by univariate and multivariate analyses. P-values of <0.05 were considered statistically significant.
RESULTS: A total of 532 patients (64.5% males) from 32 hospitals were included. The mean (SD) ages of both study groups were similar [68 (10) vs 67 (10) years, P = NS). A total of 1050 lung resections were performed (90% segmentectomies or wedge, n = 946 and 10% lobectomies or greater, n = 104). Group A included 83 (15.6%) patients who developed a total of 100 complications. These included persistent air leaks in 18, atelectasis in 13, pneumonia in 13, paralytic ileum in 12, arrhythmia in 9, acute respiratory distress syndrome in 4 and miscellanea in 31. Reoperation was performed in 5 (0.9%) patients due to persistent air leaks in 4 and lung ischaemia in 1. The mortality rate was 0.4% (n = 2). Causes of death were sepsis in 1 patient and ventricular fibrillation in 1. In the multivariate analysis, lobectomy or greater lung resection [odds ration (OR) 1.9, 95% confidence interval (95% CI) 1.04–3.3, P = 0.03], respiratory co-morbidity (OR 2.3, 95% CI 1.1–4.6, P = 0.01) and cardiovascular co-morbidity (OR 2, 95% CI 1–3.8, P = 0.02) were independent risk factors for postoperative morbidity. Videoassisted surgery vs thoracotomy showed a protective effect (OR 0.3, 95% CI 0.1–0.8, P = 0.01).
CONCLUSIONS: The first episode of lung surgery for pulmonary metastases of CRC was associated with very low mortality and reoperation rates (<1%). The postoperative morbidity rate was 16%. Independent risk factors of postoperative morbidity were major lung resection and respiratory and/or cardiovascular co-morbidity. Video-assisted surgery showed a protective effect.

Idioma: Inglés

DOI: 10.1093/ejcts/ezt459

Año: 2014

Publicado en: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY 45, 4 (2014), 671-676
ISSN: 1010-7940

Factor impacto JCR: 3.304 (2014)

Categ. JCR: SURGERY rank: 26 / 196 = 0.133 (2014) - Q1 - T1
Categ. JCR: CARDIAC & CARDIOVASCULAR SYSTEMS rank: 41 / 123 = 0.333 (2014) - Q2 - T2
Categ. JCR: RESPIRATORY SYSTEM rank: 16 / 57 = 0.281 (2014) - Q2 - T1

Tipo y forma: Article (Published version)

Área (Departamento): Área Cirugía (Dpto. Cirugía,Ginecol.Obstetr.)