• Journal of Chest Surgery
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• v.27 no.8
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• pp.677-682
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• 1994

A bronchopleural ~stula[BPF] is a major therapeutic challange to the thoracic surgeons due to difficulties in its management. We have experienced 9 cases of postpneumonectomy BPF, and all of them occured after the right side pneumonectomy. Seven patients underwent pneumonectomy due to lung cancer, and one patient each received pneumonectomy due to bronchiectasis and pulmonary tuberculosis. The most frequently used method of treatment was Eloesser operation which was done in 7 patients, and one had open thoracostomy and one had betadine irrigation until he died suddenly due to pulmonary vein rupture. The result of treatment was poor with five mortalities including one operative death. Two patients are in good condition in 28 months and 4 years of follow-up, but two are lost in follow-up. Tissue sealant such as Tisseel was used in three patients but seems to have no effect at all in the treatment of postoperative BPF.

• The Korean Journal of Physiology
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• v.17 no.1
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• pp.23-28
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• 1983

In order to clarify the effect of steroid on the pulmonary pressure-volume curve in the pneumonectomized rabbit, the right side pneumonectomy was performed under general anesthesia with pentobarbital sodium and the remaining lung was excised on the fifth day after surgery. The intrapulmonic pressure in the excised left lung was measured at 20, 25, and 30 ml lung volume during inflation and deflation period. In the steroid treated group, the intrapulmonic pressure at 20, 25, and 30 ml lung volume during inflation was significantly decreased compared with intrapulmonic pressure of the control group. But in the pneumonectomy group the decreasing tendency of the pressure was observed. During deflation, the intrapulmonic pressure at 25 ml and 20 ml was not significantly different from the control group in pneumonectomy and steroid treated pneumonectomy group. And the lung weight was measured in each experimental group and also the lung weightbody weight ratio(L/B) was calculated. The lung weight was significantly increased in both pneumonectomy and steroid treated pneumonectomy group. Calculated L/B was increased significantly in both group. Above results suggest that steroid increases the secretion of pulmonary surfactant or affects the catabolic effect on protein metabolism of connective tissue in lung parenchyma.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.145-151
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• 2024

Background: Contralateral pulmonary resection after pneumonectomy presents considerable challenges, and few reports in the literature have described this procedure. Methods: We retrospectively reviewed the medical records of all patients who underwent contralateral lung resection following pneumonectomy for any reason at our institution between November 1994 and December 2020. Results: Thirteen patients (9 men and 4 women) were included in this study. The median age was 57 years (range, 35-77 years), and the median preoperative forced expiratory volume in 1 second was 1.64 L (range, 1.17-2.12 L). Contralateral pulmonary resection was performed at a median interval of 44 months after pneumonectomy (range, 6-564 months). Surgical procedures varied among the patients: 10 underwent single wedge resection, 2 were treated with double wedge resection, and 1 underwent lobectomy. Diagnoses at the time of contralateral lung resection included lung cancer in 7 patients, lung metastasis from other cancers in 3 patients, and tuberculosis in 3 patients. Complications were observed in 4 patients (36%), including acute kidney injury, pneumothorax following chest tube removal, pneumonia, and prolonged air leak. No cases of operative mortality were noted. Conclusion: In carefully selected patients, contralateral pulmonary resection after pneumonectomy can be accomplished with acceptable operative morbidity and mortality.

• Journal of Chest Surgery
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• v.48 no.4
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• pp.252-257
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• 2015

Background: Lobectomy is the generally accepted standard treatment for early-stage non-small cell lung cancer (NSCLC). However, especially in elderly patients, it is often necessary to perform pneumonectomy in order to maximize the likelihood of curative treatment, although pneumonectomy is a challenging procedure. Methods: We analysed patients who were clinically diagnosed with stage I NSCLC and underwent pneumonectomy with curative intent from 2004 to 2011. The patients were divided into an elderly group (${\geq}70$ years) and a younger group (<70 years). We retrospectively analysed the outcomes of these groups of patients in order to characterize the role of pneumonectomy as a treatment for elderly patients with clinical stage I NSCLC. Results: Thirty patients younger than 70 years of age (younger group) and fourteen patients 70 years of age or older (elderly group) who underwent pneumonectomy were enrolled in the present study. The median follow-up period was 35 months (range, 0 to 125 months). The perioperative mortality rate (within 90 days after the operation) was 7.1% in the elderly group and 6.7% in the younger group (p=0.73). No significant differences between the two groups were observed regarding the occurrence of pneumonia, acute respiratory distress syndrome, cardiac arrhythmia, bronchopleural fistula, and vocal cord paralysis. The overall five-year survival rate was 79.4% in the younger group and 35.7% in the elderly group, which was a significant difference (p=0.018). The five-year disease-free survival rate was 66.7% in the younger group and 35.7% in the elderly group, but this difference was not statistically significant (p=0.23). Conclusion: Although elderly patients with early stage lung cancer showed a worse long-term survival rate after pneumonectomy than younger patients, the outcomes of elderly patients were similar to those of younger patients in terms of perioperative mortality and postoperative complications. Patients should not be denied pneumonectomy solely due to old age.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.535-541
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• 2002

Background: The prevalence of pulmonary tuberculosis remains high in several areas of the world, and pneumonectomy is often necessary to treat the sequelae of the disease. We retrospectively analyzed the morbidities, mortalities, and long-term outcomes after pneumonectomy for the treatment of tuberculous sequelae. Material and Method: Between 1981 and 2001, 94 patients underwent either pneumonectomy or extrapleural pneumonectomy for the treatment of tuberculous sequelae. There were 44 males and 50 females. The mean age was 40(16~68) years. The pathology included destroyed lung in 80, main bronchus stenosis in 10, and both lesions in 4. Surgical procedures were pneumonectomy in 47, extrapleural pneumonectomy in 43, and completion pneumonectomy in 4. Results: One patient died postoperatively due to empyema. Twenty-three complications occurred in 20 patients; empyema in 15(including 7 bronchopleural fistulas), wound infection in 5, and others in 3. Univariate analysis revealed presence of empyema, extrapleural pneumonectomy, prolonged operation time, and old age as risk factors of postpneumonectomy empyema. In multivariate analysis, old age and low preoperative FEV1 were risk factors of empyema. Low preoperative FEV1 was the risk factor of bronchopleural fistula(BPF) in univariate analysis. Low preoperative FEV1, positive sputum AFB, and presence of aspergilloma were risk factors of BPF in multivariate analysis. There were twelve late deaths. Actuarial 5-and 10-year survival rates were 94$\pm$3% and 87$\pm$4%, respectively. Conclusion: Pneumonectomy could be performed with acceptable mortality and morbidity, and could achieve good long-term survival for the treatment of tuberculous sequelae. In patients with risk factors, special care is recommended to prevent postoperative empyema or bronchopleural fistula.

• Journal of Chest Surgery
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• v.29 no.6
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• pp.614-620
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• 1996

The method of treatment in lung cancer patients with invasion to parietal pleura, diaphragm, peri- cardium or vertebra is controversial, and resection of these invasion together with pneumonectomy is called "complex pneumonectomy" From March 1990 to February 1994 we performed 18 cases of "complex pneumonectomy". Seven patients had resection of chest wall, 10 patients had pericardial re- section, and one patient had resection of diaphragm Right pneumonectomy was done in 8 cases and left pneumonectomy was done in 10 cases. The age of patients were from 40 to 70 years(mean 58 years) with male to female ratio of 17 to 1. The chief complaints of the patients on admission were cough (13), dyspnea on exertion (11), chest pain (10), weight loss (9), general fatigue (9), and sputum production (4 . Postoperative pathology were 13 squamous cell carcinoma, 3 adenocarcinoma, and one case each of adenosquamous carcinoma and small cell carcinoma. The postoperative pathologic stages were 2 T3NO MO, 4 TIWIMO, 6 T3N2MO, 5 T4N2MO, and 1 TIWIMO. There was one operative mortality(5.5%). Excluding one follow up loss, 14 patients expired during the follow-up and the mean survival was 9.07 $\pm$ 4.82 months. One patient with stage TINOMO who had chest wall resection is alive at 35 months follow-up and a patient with T3N2MO who had diaphragm resection is alive at 36 months follow-up. Therefore, selection of patients for "complex pneumonec- tomy" is very important, and a long term survival is possible.ong term survival is possible.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.285-291
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• 1980

Post pneumonectomy empyema either with bronchopleural fistula or without bronchopleural fistula is an infrequent postoperative complication, but very serious and critical problem. But it is of some interest that the development of a postoperative empyema following resection for carcinoma of the lung might have a favorable effect on the survival of patients in recent speculation of the literature. We have experienced 4 cases of postoperative empyema following pneumonectomy for carcinoma of the lung at department of chest surgery, Yon Sei University, medical college during 11 years from Jan. 1968 to June 1980. Histologically, 3 cases were demonstrated squamous cell carcinoma except one oat cell carcinoma. Onset of postoperative empyema occurred over a wide range of time, from as early as the 5th postoperative day to insidious onset 6 months after pneumonectomy. The most common organisms isolated from the empyema cavities were staphylococcus aureus, pseudomonas aeruginosa and gram negative bacilli. All cases had a large number of organisms and more infections but not single infection. 2 out of 4 cases are treated with open pleural window drainage and irrigation with antibiotic`s solution 2 or 3 times per week by this time and postoperative general course is not eventful. One is alive to 2 years 3 months, another is alive to 8 years 11 months until now. And 2 out of 4 patients is survived over 4 years 10 months. Analysis of postoperative empyema complicating pneumonectomy for bronchogenic carcinoma revealed an increase in 4 year 10 months survival [50%].

• Journal of Chest Surgery
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• v.41 no.6
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• pp.759-763
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• 2008

Cardiac surgery in patients with a prior pneumonectomy has a high prevalence of postoperative complications and mortality. We have successfully performed a mitral valve replacement and tricuspid annuloplasty in a 71-year-old man who had a left pneumonectomy 33 years previously due to pulmonary tuberculosis. We report this case with a literature review on the issue of the prevention perioperative pulmonary impairment, the technique of mitral valve exposure during surgery and postoperative rhythm disturbance.

• Journal of Korean Academy of Nursing Administration
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• v.10 no.3
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• pp.345-364
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• 2004

Purpose: This is develop a critical pathway as an useful alternative to the previous management system in order to restriction of medical resources, high expectation of ordinary people to health and application for DRG. Method: In order to preliminary critical pathway, we analyzed 30 cases of medical records of patients who had lobectomy and pneumonectomy at the Yonsei Medical Center in Seoul. An expert validity test was taken for the preliminary critical pathway, and clinical validity test was also done. After these processes, the final critical pathway was developed. Result: Among 10 cases, one was excluded in this study due to the complication after operation. 7 of total 9 patients were discharged earlier than the expected day, 1 patient was just discharged at the expected day, and 1 patient was discharged 4 days later than the expected day at the 12th day after operation. Conclusion: The critical pathway is developed without difficulty because the posoperative management for patients with lobectomy and pneumonectomy is uncomplicated. Therefore, if it is more researched on the clinical application, then the activity of C.Q.I. will be able to sustain the patient oriented management system.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.487-493
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• 2021

Background: Predicting postoperative lung function after pneumonectomy is essential. We retrospectively compared postoperative lung function to predicted postoperative lung function based on computed tomography (CT) volumetry and perfusion scintigraphy in patients who underwent pneumonectomy. Methods: Predicted postoperative lung function was calculated based on perfusion scintigraphy and CT volumetry. The predicted function was compared to the postoperative lung function in terms of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁), using 4 parameters: FVC, FVC%, FEV₁, and FEV₁%. Results: The correlations between postoperative function and predicted function based on CT volumetry were r=0.632 (p=0.003) for FVC% and r=0.728 (p<0.001) for FEV₁%. The correlations between postoperative function and predicted postoperative function based on perfusion scintigraphy were r=0.654 (p=0.002) for FVC% and r=0.758 (p<0.001) for FEV₁%. The preoperative Eastern Cooperative Oncology Group (ECOG) scores were significantly higher in the group in which the gap between postoperative FEV₁ and predicted postoperative FEV₁ analyzed by CT was smaller than the gap analyzed by perfusion scintigraphy (1.2±0.62 vs. 0.4±0.52, p=0.006). Conclusion: This study affirms that CT volumetry can replace perfusion scintigraphy for preoperative evaluation of patients needing pneumonectomy. In particular, it was found to be a better predictor of postoperative lung function for poor-performance patients (i.e., those with high ECOG scores).