Left versus right destroyed lung pneumonectomy:short-term and long-term prognosis and risk factors

Abstract

Abstract Aim: To compare and analyze postoperative short-term and long-term destroyed lung (DL) disease prognosis for patients undergoing left versus right pneumonectomy and to explore related risk factors. Methods: Retrospective analysis was conducted of clinical data obtained for 128 DL patients who underwent pneumonectomy in the thoracic surgery department of Beijing Chest Hospital from November 2001 to May 2022. Based on lesion site, cases were divided into two groups: a left pneumonectomy group (104 cases) and right pneumonectomy group (24 cases). Then, postoperative short-term and long-term DL disease clinical features and prognostic factors were analyzed and compared. Results: As compared with the left pneumonectomy group, the right pneumonectomy group experienced greater rates of preoperative diabetes and chronic pulmonary aspergillosis (CPA) rates and greater rates of intraoperative blood loss and postoperative respiratory failure. Right pneumonectomy group rates of rehospitalization, tuberculosis recurrence, BPF and empyema were higher than corresponding left pneumonectomy group rates. Results of binary logistic regression analysis revealed that CPA (OR: 5.234, 95% CI: 1.768-15.498) was a key risk factor for secondary respiratory failure, while residual cavity reinfection (OR: 4.402, 95% CI: 1.063-18.241) was a key risk factor for rehospitalization and right pneumonectomy was a key risk factor for tuberculosis recurrence (OR: 4.443, 95% CI: 1.241-15.907) and BPF/thoracic infection (OR: 6.713, 95% CI: 1.212-37.198). Conclusion: Patients undergoing right pneumonectomy experience poorer outcomes with regard to short-term postoperative safety and long-term prognosis as compared to left pneumonectomy patients. Furthermore, surgeons should exercise extreme caution when performing pneumonectomies on DL patients with CPA, who are most likely to experience residual cavity reinfection, in order to prevent this postoperative complication.