Lobectomia por carcinoma brônquico: análise das co-morbidades e seu impacto na morbimortalidade pós-operatória

Abstract

Objective: To analyze the impact that comorbidities have on the postoperative outcomes in patients submitted to lobectomy for the treatment of bronchial carcinoma. Methods: A retrospective study of 493 patients submitted to lobectomy for the treatment of bronchial carcinoma was conducted, and 305 of those patients met the criteria for inclusion in the final study sample. The surgical technique used was similar in all cases. The Torrington-Henderson scale and the Charlson scale were used to analyze comorbidities and to categorize patients into groups based on degree of risk for postoperative complications or death. Results: The postoperative (30-day) mortality rate was 2.9%, and the postoperative complications index was 44%.Prolonged air leakage was the most common complication (in 20.6%). The univariate analysis revealed that gender, age, smoking, neoadjuvant therapy and diabetes all had a significant impact on the incidence of complications. The factors found to be predictive of complications were body mass index (23.8 ± 4.4), forced expiratory volume in one second (74.1 ± 24%) and the ratio between forced expiratory volume in one second and forced vital capacity (0.65 ± 0.1). The scales employed proved efficacious in the identification of the risk groups, as well as in drawing correlations with morbidity and mortality (p = 0.001 and p < 0.001). In the multivariate analysis, body mass index and the Charlson index were found to be the principal determinants of complications. In addition, prolonged air leakage was found to be the principal factor involved in mortality (p = 0.01). Conclusion: Reductions in forced expiratory volume in one second, in the ratio between forced expiratory volume in one second and forced vital capacity, and in body mass index, as well as a Charlson score of 3 or 4 and a Torrington-Henderson score of 3, were associated with a greater number of postoperative complications in patients submitted to lobectomy for the treatment of bronchial carcinoma. Air leakage was found to be strongly associated with mortality.

Fatores de risco nas lobectomias realizadas para tratar o carcinoma brônquico

“…In that study, 46% of the patients developed cardiopulmonary complications, 3.3% died, and 20.7% developed air leakage. These results were similar to the 44%, 2.9%, and 20.6%, respectively, found by Sánchez et al (5) in a study published in this issue of the Brazilian Journal of Pulmonology.…”

“…In their excellent study, presented in this issue of the Brazilian Journal of Pulmonology, Sánchez et al (5) sought to establish a correlation between the various comorbidities and the incidence of complications. Although it was a retrospective study, the potential limitations of this type of analysis and the large number of analyzed variables were balanced by the exceptionally large number of surgical patients analyzed (305), as well as by an appropriate statistical study.…”

Associação independente do tabagismo aos eventos cardíacos pós-operatórios e à mortalidade em 30 dias

“…Al analizar la asociación del tabaquismo a los eventos cardiovasculares y a la mortalidad a 30 días, pocos fueron los estudios que lo consideraron como variable independiente 8,11 , pues la mayoría de los estudios reporta esta variable como uno de los factores de riesgo relacionado a los eventos pulmonares, más que a los cardiovasculares 7,8,13 .…”

“…Existen algunos pocos estudios que sugieren que la interrupción del acto de fumar en el preoperatorio podría disminuir las complicaciones pulmonares postoperatorias 13,38 . Sin embargo, el impacto en la mortalidad y en las complicaciones cardiacas postoperatorias no está claro, ni Sakuma et al Tabaquismo como factor de riesgo independiente se sabe exactamente cuál es el tiempo necesario, antes de la operación, de interrupción del tabaquismo, para que no ocurran complicaciones.…”

“…La Organización Mundial de la Salud (OMS) señala al tabaquismo como el factor de riesgo más importante asociado a la morbilidad y mortalidad cardiovasculares 13 . En Brasil, el tabaco es responsable por más de 200 mil muertes por año, siendo 15 mil solamente en el Estado de São Paulo 2,15 .…”