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Eur J Cardiothorac Surg 2002;21:951
© 2002 Elsevier Science NL
Letter to the Editor |
Department of Thoracic Surgery, Faculty of Medicine, Kyoto University, 54 Shogoin Sakyo-ku, Kyoto 606-8507, Japan
Received 7 November 2001; received in revised form 16 January 2002; accepted 30 January 2002.
* Corresponding author. Tel.: +81-75-751-3835; fax: +81-75-751-4647
e-mail: wadah{at}kuhp.kyoto-u.ac.jp
Key Words: Air leak • Lung cancer • Risk factors • Albumin • Cholinesterase
Prolonged air leak (PAL) after pulmonary resection is a common complication and a major limiting factor in early hospital discharge [1]. Although various techniques to control air leak have been advocated and performed [2], some patients persist PAL postoperatively.
We retrospectively reviewed 138 patients, 95 males and 43 females (mean age 65.9, range 37–86 years) undergoing lobectomy (n=79) or segmentectomy (n=59) for primary lung cancer from 1 January 1999 through 31 October 2000 to analyze the significance of various preoperative risk factors for postoperative PAL, which was defined as lasting for more than 10 days. A chest tube required for drainage of fluid was not considered. PAL occurred in 25 patients (18.1%), lasting an average of 20.9 (range 10–49) days, and was the most dominant complication recorded. Twelve patients with PAL (48%) were treated conservatively with continuous drainage. Thirteen patients underwent pleurodesis with successful closure of the air leak in ten patients (40%). Three patients (12%) required rethoracotomy.
We analyzed the preoperative variables in the two groups of the patients with PAL (n=25) or without PAL (n=113). A significantly (P=0.002) greater proportion of patients with PAL (seven/25) had the morbidity of diabetes mellitus than those without PAL (8/113). Seven (46.7%) of the 15 patients with diabetes mellitus developed PAL. There was a trend toward (P=0.061) that serum cholinesterase level was lower in the patients with PAL [277.2±67.9 IU/l (mean±SD)] than in those without PAL (307.2±72.5 IU/l). Serum albumin level was significantly (P=0.031) lower in the patients with PAL (41.2±4.6 g/l) than in those without PAL (42.8±3.0 g/l). There was no statistical difference in age, BMI, FEV1/FVC, absolute lymphocyte count, gender, histology, surgical modality (lobectomy versus segmentectomy), pathological stage (I and II versus III and IV), exposure to induction chemotherapy with carboplatin and paclitaxel, and cigarette index (more than 400 versus less than 400), between the groups with and without PAL.
Preoperative nutritional status is known to be associated with complication after pulmonary resection [3,4]. Such as a history of weight loss, serum albumin [4], and BMI [3] was shown to affect the morbidity in the patients undergoing thoracotomy for lung cancer. In our study, preoperative serum albumin was significant predictive variable for PAL after lobectomy or segmentectomy. Serum cholinesterase is one of the useful nutritional parameters with shorter half-life than that of albumin [5]. There have been no reports that preoperative serum cholinesterase was associated with postoperative complication following pulmonary resection. We showed the trend toward that preoperative serum cholinesterase was associated to the morbidity of PAL was shown. Furthermore, the average (167.7±41.8 IU/l) of serum cholinesterase levels in three patients sustaining rethoracotomy for PAL was significantly lower (P=0.0013) than that in the patients without PAL (307.2±72.5 IU/l).
We consider that morbidity of diabetes mellitus, and lower levels of serum albumin and cholinesterase are the preoperative predictive risk factors for PAL following lobectomy or segmentectomy for primary lung cancer.
References
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