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Eur J Cardiothorac Surg 2003;24:469-470
© 2003 Elsevier Science NL

Letter to the Editor

Reply to Kutlu

F. Javier Algar*, Antonio Álvarez, F. Javier López-Pujol

Department of Thoracic Surgery, University Hospital Reina Sofía, Avda. Menéndez Pidal s/n, 14004 Cordoba, Spain

Received 2 June 2003; accepted 9 June 2003.

* Tel./fax: +34-957-010445
e-mail: ctoracica.hrs.sspa{at}juntadeandalucia.es

Key Words: Pneumonectomy • Pulmonary complications • Risk factors

We appreciate the comments by Kutlu about our paper regarding pulmonary complications after pneumonectomy for lung cancer [1]. Pulmonary complications after lung resection, especially pneumonectomy, are frequent and are associated with high mortality rates, being the major cause of postoperative mortality following pneumonectomy. Therefore, it would be of great interest to predict which perioperative factors are associated with the development of pulmonary complications after lung resection.

Our study is based on a retrospective revision of pneumonectomies performed over a 12-year period in a single centre. In other published series, we found great variability in terms of frequency (7–49%) [2] and definition of "pulmonary complication". We have considered seven complications defined before the data collection. We agree with Dr Kutlu et al. that the classification of the pulmonary complications could have been any other less extensive, since within the definition of ALI and ARDS [3] could have been included "respiratory failure" (no 3), PPE (no 4), ventilatory dependence (no 5), and reintubation (no 6). Certainly, these four complications are closely related, however, the whole frequency of this type of complication would not have been significantly different. Moreover, the results of the multivariate analysis that predicts the risk factors involved in the development of this complication will not have changed.

Probably, in future prospective studies, we will re-classify these complications within ALI and ARDS, because there are objective criteria for its definition [4]. Unfortunately, the retrospective design of this study was a limitation to classify and analyze the pulmonary complications after pneumonectomy for lung cancer. However, we believe that the design, data collection and statistical analysis of this study were appropriate and the results completely valid. Finally, considering the large number of cases assessed, these results should be taken into account for future prospective studies regarding complications of pneumonectomies.

References

  1. Algar F.J., Alvarez A., Salvatierra A., Baamonde C., Aranda J.L., López-Pujol F.J. Predicting pulmonary complications after pneumonectomy for lung cancer. Eur J Cardiothorac Surg 2003;23:201-208.[Abstract/Free Full Text]
  2. Sthépan F., Boucheseiche S., Hollande J., Flahault A., Cheffi A., Bazelly B., Bonet F. Pulmonary complications following lung resection. A comprehensive analysis of incidence and possible risk factors. Chest 2000;118:1263-1270.[Abstract/Free Full Text]
  3. Kutlu C.A., Williams E.A., Evans T.W., Pastorino U., Goldstraw P. Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg 2000;69:376-380.[Abstract/Free Full Text]
  4. Bernard G.R., Artigas A., Brigham K.L., Carlet J., Falke K., Hudson L., Lamy M., Legall J.R., Morris A., Spragg R. The American–European consensus conference on ARDS. Definitions, mechanisms, relevant outcomes and clinical trials coordination. Am J Respir Crit Care Med 1994;149:818-824.[Abstract]




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