[Early and late postoperative complications in thoracic surgery interventions]

Two types of postoperative complications should be distinguished, i.e. early complications including a lethality within 30 days and delayed complications which may occur after several years. In the period between 8/1985 and 12/1987 216 operations were carried out on patients with bronchial carcinoma. The operative lethality rate was 2.3%. The most frequently performed operation was lobectomy with 59% followed by pneumonectomy including extended pneumonectomy with 17.5%. 57.7% of patients with bronchial carcinomata were resected in the early stage I and II, and 26.4% of patients in stage IIIa. Squamous cell carcinomata occurred most frequently, with an incidence of 41%. Of the common postoperative complications cardiac arrhythmia was to be found most often (27%). Pulmonary embolism developed in 5% of all cases, cerebral complications in 3.7%, wound infections in 2.3% and post-operative haemorrhages in 1.3%. Bronchus stump insufficiency and dehiscence of suture were found in 2.2%, and pleural empyema in 4.2% of the complications directly resulting from the operation. Only 6 of 9 patients had suffered an persistent bronchopleural fistula lasting 7 days. Infections of the respiratory tree were identified in 18.3% and pneumonia in only 8.3% of cases. Delayed empyemas and bronchus fistulas belong in the category of delayed complications. The risk of deformation of the vertebral column caused by processes of involution in the cavity of pneumonectomy should be kept in mind following pneumonectomy. A distinction shall be made between the postthoracotomy syndrome an classical intercostal neuralgia, which has a sharply defined clinical picture and may be treated by operative neurolysis or resection of the nerve.