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Árangur lungnabrottnámsaðgerða við lungnakrabbameini á Íslandi

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Authors
Húnbogi Þorsteinsson
Steinn Jónsson
Hörður Alfreðsson

Helgi J. Ísaksson
Tómas Guðbjartsson
Issue Date
2009-12-01

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Other Titles
Results of pneumonectomy for non-small cell lung cancer in Iceland
Citation
Læknablaðið 2009, 95(12):823-9
Abstract
OBJECTIVE: Study the indications, complications and surgical outcome of pneumonectomy for non small cell lung cancer (NSCLC) in Iceland MATERIAL AND METHODS: A retrospective study of all pneumonectomies performed for NSCLC in Iceland from 1988 to 2007. Information was obtained from medical records and data on operative indications, postoperative TNM stage, complications, survival and survival predictors was analysed. RESULTS: 77 patients (64% males) with mean age of 62.3 yrs. were operated on, 44% on the right side. Mediastinoscopy was performed in 31% of cases. Most patients were stage I or II (58%), but 17 and 21% were stage III A and IIIB, respectively. Mean operation time was 161 min., bleeding 1.1 L and hospital stay 11 days. Atrial fibrillation (21%), pneumonia (6.5%), empyema (5.5%) and respiratory failure (5%) were the most common complications. Three (3.9%) patients died within 30 days from surgery. Five year survival was 20.7%. Age, history of COPD, adenocarcinoma histology and advanced TNM stage were independent predictors of poor survival. CONCLUSIONS: Pneumonectomies for NSCLC in Iceland have a low rate of complications and operative mortality. However, long term survival is lower than expected, and many patients (27%) were in advanced stages. This is most likely due to inadequate preoperative staging.
TILGANGUR: Kanna árangur og ábendingar lungnabrottnámsaðgerða (pneumonectomy) við lungnakrabbameini á Íslandi.
 EFNIVIÐUR OG AÐFERÐIR: Afturskyggn rannsókn á sjúklingum sem gengust undir lungnabrottnám vegna lungnakrabbameins á Íslandi 1988-2007. Kannaðar voru ábendingar aðgerðar, TNM-stig, fylgikvillar, lífshorfur og forspárþættir lífshorfa.
 NIÐURSTÖÐUR: 77 sjúklingar (meðalaldur 62,3 ár, 64% karlar) gengust undir lungnabrottnám, í 44% tilfella hægra megin. Miðmætisspeglun var gerð í 31% tilfella. Stigun eftir aðgerð sýndi að 41 sjúklingur (54%) var á stigi I+II, 27 (38%) á stigi IIIA/B og 6 á stigi IV. Í 17% tilfella sást krabbamein í skurðbrún. Aðgerðartími var að meðaltali 161 mínúta, blæðing í aðgerð 1,1 L og miðgildi legutíma 11 dagar. Helstu fylgikvillar eftir aðgerð voru gáttatif/flökt (21%), lungnabólga (6,5%), fleiðruholssýking (5,2%) og öndunarbilun (5,2%). Þrír sjúklingar (3,9%) létust <30 daga frá aðgerð og fimm ára lífshorfur voru 20,7%. Hækkandi aldur, saga um lungnateppu, kirtilmyndandi vefjagerð og hátt TNM-stig höfðu neikvæð áhrif á lífshorfur samkvæmt fjölþáttagreiningu.
 ÁLYKTUN: Skammtímaárangur lungnabrottnáms-aðgerða er góður hér á landi og tíðni alvarlegra fylgikvilla lág. Lífshorfur eru hins vegar lakari en búast mætti við, eða 20,7% eftir fimm ár. Skýring á þessu gæti falist í ófullnægjandi stigun, en aðeins þriðjungur sjúklinga gekkst undir miðmætisspeglun fyrir aðgerð. 
 

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