Zentralbl Chir 2014; 139 - H_10_5
DOI: 10.1055/s-0034-1389344

Emergent pneumonectomy for lung gangrene – does the outcome warrant the procedure?

M Schweigert 1, C Giraldo Ospina 2, N Solymosi 3, R Karmy-Jones 4, A Dubecz 1, M Jiménez Fernández 5, D Öfner 6, HJ Stein 1
  • 1Klinikum Nürnberg
  • 2Hospital Universitario Virgen de las Nieves Granada
  • 3Szent István University Budapest
  • 4PeaceHealth Southwest Medical Center Vancouver
  • 5Hospital Universitario de Getafe Madrid
  • 6Salzburger Landeskrankenhaus

Objective:

Sloughing and gangrene of a complete lung are only very infrequently encountered complications of necrotizing pneumonia and fulminant pulmonary abscess formation. Thus far the role of emergent pneumonectomy is not established.

Material and Methods:

The outcome of patients who underwent anatomic lung resection for lung gangrene at three centres for thoracic surgery (USA, Germany and Spain) during the last 13 years was retrospectively analyzed. Only cases of necrotizing pneumonia were included whereas malignant lesions were kept out. The study was approved by a local ethics committee.

Results:

Overall 44 patients were indentified (average age 56.3 years). Pulmonary sepsis (27/44), pleural empyema (29/44), persistent air leakage (14/44) and respiratory failure with mechanical ventilation (14/44) were already preoperatively present. The mean Charlson-index-of-comorbidity was 2.77. Procedures were segmentectomy (7), lobectomy (26) and pneumonectomy (11). In-hospital-mortality was 7/44; 2 following pneumonectomy and 5 after lobectomy.

In comparing the pneumonectomy-group with the lobectomy-group we found no significant differences in age (p = 0.59), Charlson-index-of-comorbidity (p = 0.18) and postoperative mortality (p = 1). Charlson-index-of-comorbidity ≥3 (OR: 8,41; 95% CI: 0.88 – 421.71; p = 0.04), preoperative pleural empyema (OR: 3.56; 95% CI: 0.37 – 179.62; p = 0.39) and preoperative persistent air leak (OR: 7.34; 95% CI: 1.00 – 89.98; p = 0.02) were associated with higher risk for fatal outcome. Furthermore patients with sepsis (p = 0.03) and patients sustaining acute renal failure (p = 0.04) had significant higher mortality.

Conclusions:

Pulmonary sepsis and its complications as well as preexisting comorbidity are the major reasons for fatal outcome whereas the extent of surgical resection shows no significant influence. Emergent pneumonectomy as ultimate ratio is not only justified but also life saving. Further improvement seems achievable by earlier surgical intervention before the onset of pulmonary sepsis.