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Urgent lobectomy and pneumonectomy

E H Carrillo1, E F Block, R Zeppa

  • 1Division of Trauma, Department of Surgery, University of Miami School of Medicine, Florida 33101, USA.

European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine
|September 1, 1994
PubMed
Summary
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Penetrating thoracic trauma requiring pulmonary resection has high mortality, especially from handgun injuries. Prompt initial resuscitation and staged definitive surgery are crucial for managing these severe chest injuries.

Area of Science:

  • Trauma Surgery
  • Thoracic Surgery
  • Emergency Medicine

Background:

  • Civilian experience with pulmonary resections for penetrating thoracic trauma is limited.
  • Previous reports focused on battlefield management of these injuries.
  • Urgent thoracotomies are performed for severe chest trauma, with a subset requiring formal lung resection.

Purpose of the Study:

  • To review civilian experience with lobectomies and pneumonectomies for penetrating thoracic trauma.
  • To identify common etiologies, complications, and outcomes.
  • To evaluate mortality rates associated with different resection types.

Main Methods:

  • Retrospective review of 43 patients undergoing lobectomy or pneumonectomy for penetrating thoracic trauma over 3 years.

Related Experiment Videos

  • Analysis of etiologic agents, indications for surgery, complications, and mortality.
  • Categorization of deaths into intraoperative and late (sepsis, MODS).

    • Main Results:

    • Handguns were the primary cause (95%).
    • Indications were bleeding (93%) or bronchial injuries (7%).
    • High complication rates included pneumonia (87%), respiratory failure (62%), wound infection, hemorrhage, empyema (16% each), and bronchopleural fistulas (8%).
    • Mortality was 44% overall, with 66% for pneumonectomy and 38% for lobectomy.
    • 53% of deaths occurred intraoperatively; late deaths were due to sepsis and MODS.

    Conclusions:

    • Pulmonary resections for penetrating thoracic trauma carry significant morbidity and mortality.
    • Prompt initial resuscitation followed by staged definitive surgery is essential.
    • Management requires a multidisciplinary approach to address complex injuries and complications.