Indications and outcomes of pneumonectomy for benign diseases: A single-center experience

Essam Mohamed; Ayman  Abdel Ghaffar; Wesam  Aboelwafa; Hamdy   Mohammadien

doi:10.35810/ects.v3i3.140

Essam Mohamed Department of Cardiothoracic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt https://orcid.org/0000-0001-6466-0364
Ayman Abdel Ghaffar Department of Cardiothoracic Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
Wesam Aboelwafa Department of Anesthesia and Intensive care , Faculty of Medicine, Sohag University, Sohag, Egypt
Hamdy Mohammadien Department of Chest Diseases, Faculty of Medicine, Sohag University, Sohag, Egypt

DOI: https://doi.org/10.35810/ects.v3i3.140

Keywords: Destroyed lung, Pneumonectomy, Bronchiectasis, Benign pneumonectomy, Pulmonary tuberculosis

Abstract

Background: Pneumonectomy can be used to manage destroyed lung; however, it is associated with a high risk of complications. This study analyzed the outcomes of pneumonectomy in patients with destroyed lungs.

Methods: The study included 28 patients who had pneumonectomy for benign lung diseases from January 2011 to December 2017. Descriptive analysis was used to present patients' demographics, surgical details, and postoperative outcomes. Intraoperative blood loss was compared in tuberculous vs. non-tuberculous patients and those who had extrapleural vs. intrapleural pneumonectomy.

Results: The study included 11 (39%) males, and the mean age was 36.6 ± 9.8 years (range: 5– 61). The persistent cough was the presenting symptom in 93% of cases, expectoration in 78.6%, hemoptysis in 46.4%, and chest pain in 28.6% of patients. Indications for pneumonectomy were tuberculosis in 13 (46.4%), septic bronchiectasis in 10 (35.7%), invasive opportunistic infections in 3 (10.7%), neglected endobronchial foreign body in 1 (3.6%), and neglected rupture bronchus in 1 (3.6%) patient. Pneumonectomy was left-sided in 21 (75%) patients. We performed extrapleural pneumonectomy in 7 (25%) patients, intra-pericardial isolation in 5 (17.9%) patients, and two patients (7.2%) had completion pneumonectomy. Mean perioperative bleeding was 390.7± 233.8 ml. The intraoperative blood loss was more in patients with tuberculosis and extrapleural pneumonectomy (P< 0.05). Postoperative complications occurred in 7 patients (25%), and we reported one operative mortality.

Conclusions: Pneumonectomy for benign lung disease is a challenging procedure. Destroyed lung due to TB and bronchiectasis are the most common indications. The outcome could be improved with careful patient selection, appropriate preoperative preparation, meticulous operative techniques, and high postoperative care standards.