Lung carcinoma under combined and competitive pathologies: prognosis of radical surgery

Abstract

We summarized 20-year (1981 to 2001) experience of scheduled surgical treatment of 1,307 lung carcinoma patients. Postoperative mortality was 1.7 %, of them 2.4 % in 635 pulmonectomy cases, 1.2 % in 672 lobectomy and bilobectomy cases. A complex math analysis was performed based on operation outcomes in 650 patients at the N.N.Burdenko surgical clinic from 1972 to 2002. This allowed to detail 16 significant criteria of operative risk which are given according to their importance: 1) malignancy as the main pathology; 2) chronic lung diseases with severe respiratory failure; 3) traumatic volume of the intervention; 4) severe obesity; 5) drug allergic reactions; 6) blood group A, Rh-positive; 7) males; 8) left ventricle ejection fraction < 49 %; 9) severe stable angina; 10) chronic hepatic failure; 11) 2 previous abdominal surgical interventions; 12) length of a malignant disease precedes 1 year; 13) smoking; 14) moderate arterial hypertension; 15) previous thoracotomy; 16) chronic renal failure as a competitive pathology. This classification can be applied to predict an outcome of a scheduled surgical intervention. Preliminary assessed significance of this classification precedes those of wide-spread Northern American prognostic systems (APACHE — Acute Physiology Assessment and Chronic Health Evaluation — I—III; SAPS — Simplified Acute Physiology Score; SOFA — Sepsis-Related Organ Failure Assessment; MPM — Mortality Prediction Model).