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Motono N, Mizoguchi T, Ishikawa M, Iwai S, Iijima Y, Uramoto H. Analysis of risk factors of postoperative complication for non-small cell lung cancer. BMC Pulm Med 2024; 24:333. [PMID: 38987733 PMCID: PMC11238410 DOI: 10.1186/s12890-024-03054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/07/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND The relationship between risk factors of common postoperative complications after pulmonary resection, such as air leakage, atelectasis, and arrhythmia, and patient characteristics, including nutritional status or perioperative factors, has not been sufficiently elucidated. METHODS One thousand one hundred thirty-nine non-small cell lung cancer patients who underwent pulmonary resection were retrospectively analyzed for risk factors of common postoperative complications. RESULTS In a multivariate analysis, male sex (P = 0.01), age ≥ 65 years (P < 0.01), coexistence of chronic obstructive pulmonary disease (COPD) (P < 0.01), upper lobe (P < 0.01), surgery time ≥ 155 min (P < 0.01), and presence of lymphatic invasion (P = 0.01) were significant factors for postoperative complication. Male sex (P < 0.01), age ≥ 65 years (P = 0.02), body mass index (BMI) < 21.68 (P < 0.01), coexistence of COPD (P = 0.02), and surgery time ≥ 155 min (P = 0.01) were significant factors for severe postoperative complication. Male sex (P = 0.01), BMI < 21.68 (P < 0.01), thoracoscopic surgery (P < 0.01), and surgery time ≥ 155 min (P < 0.01) were significant risk factors for postoperative air leakage. Coexistence of COPD (P = 0.01) and coexistence of asthma (P < 0.01) were significant risk factors for postoperative atelectasis. Prognostic nutrition index (PNI) < 45.52 (P < 0.01), lobectomy or extended resection more than lobectomy (P = 0.01), and surgery time ≥ 155 min (P < 0.01) were significant risk factors for postoperative arrhythmia. CONCLUSION Low BMI, thoracoscopic surgery, and longer surgery time were significant risk factors for postoperative air leakage. Coexistence of COPD and coexistence of asthma were significant risk factors for postoperative atelectasis. PNI, surgery time, and surgical procedure were revealed as risk factors of postoperative arrhythmia. Patients with these factors should be monitored for postoperative complication. TRIAL REGISTRATION The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Takaki Mizoguchi
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1- 1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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Kang D, Lei C, Zhang Y, Wei X, Dai W, Xu W, Zhang J, Yu Q, Su X, Huang Y, Shi Q. Shortness of breath on the day of discharge: an early alert for post-discharge complications in patients undergoing lung cancer surgery. J Cardiothorac Surg 2024; 19:398. [PMID: 38937786 PMCID: PMC11210099 DOI: 10.1186/s13019-024-02845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
PURPOSE Symptom assessment based on patient-reported outcome (PRO) can correlate with disease severity, making it a potential tool for threshold alerts of postoperative complications. This study aimed to determine whether shortness of breath (SOB) scores on the day of discharge could predict the development of post-discharge complications in patients who underwent lung cancer surgery. METHODS Patients were from a study of a dynamic perioperative rehabilitation cohort of lung cancer patients focusing on patient-reported outcomes. Patients were assessed using the Perioperative Symptom Assessment Scale for Lung surgery (PSA-Lung). Logistic regression model was used to examine the potential association between SOB on the day of discharge and complications within 3 months after discharge. The post-discharge complications were taken as the anchor variable to determine the optimal cutpoint for SOB on the day of discharge. RESULTS Complications within 3 months post-discharge occurred in 71 (10.84%) of 655 patients. Logistic regression analysis revealed that being female (OR 1.764, 95% CI 1.006-3.092, P < 0.05) and having two chest tubes (OR 2.026, 95% CI 1.107-3.710, P < 0.05) were significantly associated with post-discharge complications. Additionally, the SOB score on the day of discharge (OR 1.125, 95% CI 1.012-1.250, P < 0.05) was a significant predictor. The optimal SOB cutpoint was 5 (on a scale of 0-10). Patients with an SOB score ≥ 5 at discharge experienced a lower quality of life 1 month later compared to those with SOB score<5 at discharge (73 [50-86] vs. 81 [65-91], P < 0.05). CONCLUSION SOB on the day of discharge may serve as an early warning sign for the timely detection of 3 month post-discharge complications.
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Affiliation(s)
- Dan Kang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Cheng Lei
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yong Zhang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Xu
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Jingyu Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qingsong Yu
- Chengdu Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, China
| | - Xueyao Su
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yanyan Huang
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, People's Republic of China.
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China.
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China.
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Strollo DC, Donnenberg VS, Madan S, Moran PL, Luketich JD, Sanchez MV. Right middle lobe syndrome after upper lobectomy: Role of the bronchial angle. Asian Cardiovasc Thorac Ann 2023; 31:215-220. [PMID: 36514840 PMCID: PMC11199077 DOI: 10.1177/02184923221144402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Right middle lobe syndrome is part of a spectrum of relatively rare but serious conditions that may occur following right upper lobectomy. We aimed to assess whether the preoperative middle lobe bronchial angle on CT predicted patients at risk of developing middle lobe syndrome. METHOD All patients who had a complete upper lobectomy over 4 years were retrospectively reviewed for clinical and imaging findings of middle lobe syndrome. Patients with previous lung surgery, preoperative chemo- or radiation therapy, or more extensive surgical resection were excluded. Patient demographics and symptoms, the surgical, pathologic and bronchoscopy reports, and pre- and post-operative chest imaging, to include 3D CT reconstructions and measurements of the middle lobe angles in a subset of patients, were retrospectively reviewed. RESULT One hundred and twenty-eight patients met inclusion criteria. Ten (8%) had middle lobe syndrome based on symptoms and imaging features. Eight had severe middle lobe consolidation. Two had postoperative onset of wheezing, with middle lobe bronchial abnormality on CT. The pre- and postoperative middle lobe bronchial angles of 14 patients without middle lobe syndrome were compared to 10 patients with middle lobe syndrome. The middle lobe bronchus was completely obliterated postoperatively and could not be determined in 1 patient. There was no significant difference between the pre- and postoperative angles in patients with or without middle lobe syndrome. CONCLUSION Middle lobe syndrome occurred in 8% of patients with right upper lobectomy. The preoperative middle lobe bronchial angle did not predict patients at risk for developing middle lobe syndrome.
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Affiliation(s)
- Diane C Strollo
- Department of Cardiothoracic Surgery, Thoracic Imaging, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vera S Donnenberg
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Hillman Cancer Research Pavilion, Pittsburgh, PA, USA
| | - Shobhit Madan
- IQVIA Biotech, Clinical Project Management, Gibsonia, PA, USA
| | | | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Manuel Villa Sanchez
- Department of Cardiothoracic Surgery, Northwell Health Physician Partners, North Shore Long Island Jewish Medical Center, Staten Island, NY, USA
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Motono N, Ishikawa M, Iwai S, Yamagata A, Iijima Y, Uramoto H. Analysis of risk factors for postoperative complications in non-small cell lung cancer: comparison with the Japanese National Clinical Database risk calculator. BMC Surg 2022; 22:180. [PMID: 35568860 PMCID: PMC9107161 DOI: 10.1186/s12893-022-01628-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although the risk calculator of the National Clinical Database (RC-NCD) has been widely used to predict the occurrence of mortality and major morbidity in Japan, it has not been demonstrated whether a correlation between the calculated RC-NCD risk score and the actual occurrence of mortality and severe morbidity exists. Methods The clinical data of 585 patients who underwent pulmonary resection for non-small cell lung cancer were collected, and the risk factors for postoperative morbidity were analyzed to verify the validity of the RC-NCD. Results The coexistence of asthma (p = 0.02), nutrition lymphocyte ratio (p = 0.04), and pulmonary lobe (p < 0.01) were significant risk factors for postoperative morbidity in the present study, and the percent-predicted vital capacity (p < 0.01), pulmonary lobe (p = 0.03), and type of operative procedure (p = 0.01) were significant risk factors for severe postoperative morbidity. Furthermore, in patients received lobectomy, coexistence of asthma (p = 0.01) and pulmonary lobe (p < 0.01) were identified as significant risk factors for postoperative morbidity. Meanwhile, male sex (p = 0.01), high BMI (p < 0.01), low vital capacity (p = 0.04), and pulmonary lobe (p = 0.03) were identified as significant risk factors for severe postoperative morbidity. Conclusions Given that the pulmonary lobe was a significant risk factor for postoperative morbidity in patients received pulmonary resection and for severe postoperative morbidity in patients received lobectomy, the RC-NCD for postoperative morbidity needs to be modified according to high-risk lobes. Trial registration: The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Aika Yamagata
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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Mizukami Y, Takahashi Y, Maki R, Adachi H. Risk factors for atelectasis of the middle lobe after right upper lobectomy: preoperative bronchial diameter and stapling of the fissure. J Thorac Dis 2021; 13:5649-5657. [PMID: 34795915 PMCID: PMC8575799 DOI: 10.21037/jtd-21-1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022]
Abstract
Background Atelectasis of the middle lobe after right upper lobectomy is often seen. However, the risk factors for atelectasis are uncertain. Therefore, we assessed cases in our institution and investigated risk factors for atelectasis of the middle lobe following right upper lobectomy. Methods We identified 354 cases in which right upper lobectomy had been performed in our institution between January 2009 and December 2018, and 342 were included in this retrospective analysis. We divided patients into two groups according to the presence of postoperative atelectasis of the middle lobe, and then preoperative clinical variables and perioperative variables were compared between the two groups. Multivariable analyses for postoperative atelectasis of the middle lobe were performed using the logistic regression model. Results Middle lobe atelectasis was detected in 59 cases (17.3%). Multivariable analysis demonstrated that the preoperative diameter of the middle lobe bronchus [P=0.012; confidence interval (CI), 0.525–0.930] and stapling of the fissure between the upper and middle lobes (P=0.004; CI, 1.997–37.050) were independent risk factors for postoperative atelectasis of the middle lobe. Conclusions A small preoperative diameter of the middle lobe bronchus and stapling of the fissure between the upper and middle lobes are risk factors for middle lobe atelectasis following right upper lobectomy.
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Affiliation(s)
- Yasushi Mizukami
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
| | - Yuki Takahashi
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
| | - Ryunosuke Maki
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
| | - Hirofumi Adachi
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Hokkaido, Japan
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Motono N, Ishikawa M, Iwai S, Iijima Y, Usuda K, Uramoto H. Individualization of risk factors for postoperative complication after lung cancer surgery: a retrospective study. BMC Surg 2021; 21:311. [PMID: 34261455 PMCID: PMC8278712 DOI: 10.1186/s12893-021-01305-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk factors for postoperative complications after pulmonary resection in patients with non-small cell lung cancer (NSCLC) have not been elucidated. METHODS Clinical data of 956 patients with NSCLC were analyzed. Patient factors such as sex, age, comorbidities, smoking history, respiratory function, and the lobe involved in lung cancer and operative factors such as operative approach and operative procedures were collected and analyzed. RESULTS Male sex (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.09-2.75, p = 0.01), coexistence of asthma (OR 2.68, 95% CI 1.19-6.02, p = 0.01), low percentage of forced expiratory volume in 1 s (FEV1) (OR 1.41, 95% CI 1.02-1.95, p = 0.03), and lobectomy or greater resection (OR 2.47, 95% CI 1.66-3.68, p < 0.01) were identified as significant risk factors for postoperative complications. Male sex (OR 1.98; 95% CI 1.03-3.81, p = 0.03) and complete video-assisted thoracic surgery and robot-assisted thoracic surgery (OR 1.64; 95% CI 1.09-2.45; p = 0.01) were identified as significant risk factors for postoperative air leakage. Coexistence of asthma (OR 9.97; 95% CI 3.66-27.38; p < 0.01) was identified as a significant risk factor for postoperative atelectasis or pneumonia. Lobectomy or greater resection (OR 19.71; 95% CI 2.70-143.57; p < 0.01) was identified as a significant risk factor for postoperative arrhythmia. CONCLUSION Male sex, coexistence of asthma, low percentage of FEV1, and operative procedure were significant risk factors for postoperative complications. Furthermore, risk factors varied according to postoperative complications.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
| | - Masahito Ishikawa
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Shun Iwai
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Katsuo Usuda
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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Yanagihara T, Sekine Y, Sugai K, Kawamura T, Maki N, Saeki Y, Kitazawa S, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Sato Y. Risk factors of middle lobe bronchus kinking following right upper lobectomy. J Thorac Dis 2021; 13:3010-3020. [PMID: 34164192 PMCID: PMC8182536 DOI: 10.21037/jtd-21-105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The incidence rate of kinking of the middle lobe bronchus following right upper lobectomy is higher compared to that with residual lung bronchus following other lobectomies. Bronchial kinking was presumed to be caused by the displacement of the residual lung lobes, but its etiology is unclear. Moreover, prevention methods and effective treatments have not yet been established. The purpose of this study was to investigate the risk factors and etiology of middle lobe bronchus kinking and discuss prevention methods. Methods Patients who underwent right upper lobectomy in our hospital were retrospectively evaluated. Patient clinical characteristics, lung function, and lung lobe volume, surgical procedure were analyzed in association with the incidence of middle lobe bronchus kinking. The association between the displacement of residual lung lobes after operation and the incidence of middle lobe bronchus kinking was analyzed to assess the etiology. Results A total of 175 patients were enrolled in the risk analysis. Middle lobe bronchus kinking was observed in 5 patients (2.9%). The low percentage of forced expiratory volume percentage in 1 second (P=0.021), the low volume ratio of the right middle lobe (RML) to the right thoracic cavity (RTC) (P=0.016), and the low volume ratio of RML to right upper lobe (RML/RUL) (P=0.006) were significant risk factors of middle lobe bronchus kinking. In the patients who underwent CT at 6 months after surgery, the degree of the cranial displacement of RML was associated with the incidence of middle lobe bronchus kinking (P=0.025). Conclusions The risk of middle lobe bronchus kinking could be assessed preoperatively by calculating the volume ratio of RML/RTC and RML/RUL. The displacement of RML could be associated with the incidence of middle lobe bronchus kinking.
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Affiliation(s)
- Takahiro Yanagihara
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasuharu Sekine
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazuto Sugai
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoyuki Kawamura
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoki Maki
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yusuke Saeki
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shinsuke Kitazawa
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naohiro Kobayashi
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shinji Kikuchi
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Lee DK, Kang SW, Kim HK, Kim HS, Kim H. Effect of sugammadex on chest radiographic abnormality in the early postoperative period after video-assisted thoracoscopic lobectomy. Turk J Med Sci 2020; 50:1236-1246. [PMID: 32366060 PMCID: PMC7491306 DOI: 10.3906/sag-2001-26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background/aim Sugammadex, which offsets the effects of neuromuscular blocking agents (NMBs), has advantages over traditional reversal agents like pyridostigmine, as it enables fast and reliable recovery from neuromuscular blockade. This study compared the incidence of early postoperative chest radiographic abnormalities (CRA) between sugammadex (group S) and pyridostigmine (group P) following video-assisted thoracoscopic (VAT) lobectomy for lung cancer. Materials and methods We performed a retrospective cohort analysis by reviewing the medical records of patients who underwent VAT lobectomy at a single university medical center. We defined the early postoperative CRA as a characteristic appearance on chest radiograph up to 2 days after surgery. Arterial blood gas analysis (ABGA), surgical time, anaesthesia time, extubation time, and the total dose of rocuronium were analysed. Postoperative nausea and vomiting (PONV) and pain scores were observed until 2 days after surgery. Results A total of 257 patients underwent VAT lobectomy during the study period; 159 were included in the final analysis. Ninety patients received sugammadex while 69 received pyridostigmine. The incidence of early postoperative atelectasis was significantly lower in group S than in group P (26.7%, 95% CI: 17.5%‒35.8% and 43.5%, 95% CI: 31.8%‒55.2%, respectively, P = 0.013). The median dose of rocuronium was higher in group S than in group P (120 mg vs. 90 mg, P < 0.001). ABGA, extubation time, and PONV were similar in both groups. Conclusion Sugammadex decreased the incidence of CRA in the early postoperative period despite higher NMB consumption.
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Affiliation(s)
- Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung Wook Kang
- Department of Anesthesiology and Pain Medicine, Nowon Chuck Hospital, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyo Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Postoperative complications of pulmonary resection. Clin Radiol 2020; 75:876.e1-876.e15. [PMID: 32600652 DOI: 10.1016/j.crad.2020.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/06/2020] [Indexed: 12/25/2022]
Abstract
Thoracic surgery has seen a resurgence in recent years with increasing numbers of cases taken on since the mid-2000s. There has been a paradigm shift in how we manage lung cancer with more emphasis on surgical resection, and this has been aided by minimally invasive video-assisted thoracic surgery (VATS) techniques. As a result, the prevalence of postoperative findings and complications is also increasing, and it is increasingly important for the general radiologist to recognise and diagnose these conditions as thoracic surgical patients may present acutely to non-thoracic surgical institutions. This review will cover both the early and late complications following a variety of lung resection surgeries.
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Koike Y, Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Postsurgical residual lung complications following left upper trisegmentectomy. Eur J Cardiothorac Surg 2020; 57:472-477. [PMID: 31647548 DOI: 10.1093/ejcts/ezz273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Segmentectomy has become an increasingly popular surgical procedure for small-sized lung lesions. Left upper trisegmentectomy (LUTS) is one of the most common segmentectomies performed because of its relative ease and simplicity; however, limited information is currently available on the specific postoperative complications associated with this procedure. METHODS Among 2060 surgically resected cases in our institute between 2009 and 2016, 129 (6.2%) underwent LUTS. Postoperative chest X-rays and/or thoracic computed tomography (CT) scans were retrospectively assessed for all cases to assess postsurgical residual lung complications following LUTS. We categorized cases into 4 groups: type A (atelectasis of the lingular segment), type B (lung torsion of the lingular segment), type C (necrosis of the 'isolated segment') and type D (haematoma along stapling lines). RESULTS Postsurgical lung complications following LUTS were observed in 17 (13.1%) patients (type A: n = 7, type B: n = 1, type C: n = 4 and type D: n = 5). Three patients (2.3%) required surgical intervention because of type B (n = 1) and type C (n = 2), namely, decreased permeability and remaining ground glass opacities in the residual lung, showing an exacerbated systemic inflammatory response. In contrast, type A and D cases were successfully observed by chest CT without any surgical intervention, and patients recovered within a few months of surgery. CONCLUSIONS We identified several postoperative residual lung complications following LUTS. Lung torsion or necrosis of the residual segment may require intensive care, including reoperation. Potentially serious complications always need to be ruled out after LUTS when radiological consolidation is detected postoperatively.
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Affiliation(s)
- Yutaro Koike
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Pipanmekaporn T, Bunchungmongkol N, Punjasawadwong Y, Lapisatepun W, Tantraworasin A, Saokaew S. A risk score for predicting respiratory complications after thoracic surgery. Asian Cardiovasc Thorac Ann 2019; 27:278-287. [PMID: 30857395 DOI: 10.1177/0218492319835994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Respiratory complications are some of the most common complications following thoracic surgery and can lead to higher perioperative morbidity and mortality. The purpose of this study was to develop a simple clinical score for prediction of respiratory complications after thoracic surgery, and determine the internal validity. METHODS In this retrospective cohort study, all consecutive patients were aged 18 years and over and undergoing non-cardiac thoracic surgery at a tertiary-care university hospital. Respiratory complications included bronchospasm, atelectasis, pneumonia, respiratory failure, and adult respiratory distress syndrome within 30 days of surgery or before discharge. RESULTS A total of 1488 patients were included over a 7-year period, and 15.8% (235 of 1488 patients) developed respiratory complications. The significant predictors of respiratory complications were chronic obstructive pulmonary disease, American Society of Anesthesiologist physical status ≥ 3, right-sided surgery, duration of surgery longer than 180 min, preoperative arterial oxygen saturation on room air < 96%, and open thoracotomy. The area under receiving operating characteristic curve was 0.78 (95% confidence interval: 0.75-0.82) and 0.76 (95% confidence interval: 0.70-0.83) for the derivation and validation cohorts, respectively. The model was well calibrated with a Hosmer-Lemeshow goodness-of-fit of 7.32 ( p = 0.293). CONCLUSIONS This study developed and internally validated a simple clinical risk score for prediction of respiratory complications following thoracic surgery. This score can be used to stratify high-risk patients, address modifiable risk factors for respiratory complications, and provide preventive strategies for improving postoperative outcomes.
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Affiliation(s)
- Tanyong Pipanmekaporn
- 1 Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,2 Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Yodying Punjasawadwong
- 1 Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worawut Lapisatepun
- 1 Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- 2 Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,3 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surasak Saokaew
- 4 Center of Health Outcomes Research and Therapeutic Safety, School of Pharmaceutical Sciences, University of Phayao, Thailand.,5 Center of Pharmaceutical Outcome Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,6 Unit of Excellence on Herbal Medicine, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,7 School of Phamacy, Monash University Malaysia, Malaysia
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12
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Aloud A, Berdine G, Nugent K. Single lung ventilation in patients undergoing lobectomy. J Thorac Dis 2019; 10:6383-6387. [PMID: 30746170 DOI: 10.21037/jtd.2018.11.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Abdurahim Aloud
- Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Gilbert Berdine
- Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth Nugent
- Department of Internal Medicine at Texas Tech University Health Sciences Center, Lubbock, TX, USA
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13
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Yoshimi K, Oh S, Suzuki K, Kodama Y, Sekiya M, Seyama K, Fukuchi Y. Impact of Airflow Limitation on Comorbidities and Postoperative Complications in Patients Undergoing Thoracic Surgery: A Retrospective Observational Study. Ann Thorac Cardiovasc Surg 2016; 22:146-52. [PMID: 26935262 DOI: 10.5761/atcs.oa.15-00301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the frequency of airflow limitation (AFL), and the relationship between AFL and preoperative comorbidities or postoperative complications in patients who had undergone thoracic surgery. METHODS The medical records of patients who underwent non-cardiac thoracic surgery at our institution between August 1996 and January 2013 were retrospectively reviewed. On the basis of preoperative pulmonary function tests, patients were classified with those with FEV1/FVC <70% [AFL(+) group] or with FEV1/FVC ≥70% [AFL(-) group]. Patient characteristics, preoperative comorbidities and postoperative complications were compared between the groups. RESULTS Of the 3667 patients assessed, 738 (20.1%) were allocated to the AFL(+) group. AFL was an independent risk factor for three preoperative comorbidities: chronic obstructive pulmonary disease (odds ratio [OR]: 4.65), bronchial asthma (OR 4.30) and cardiac diseases (OR 1.41). Airflow limitation was also an independent risk factor for postoperative respiratory failure including long-term oxygen therapy (OR 2.14) and atelectasis (OR 1.90) in the patients who underwent lobectomy or partial resection of the lung. CONCLUSIONS Our retrospective study revealed that careful attention needs to be paid to airflow limitation in patients who undergo non-cardiac thoracic surgery since it appears to be an important feature of preoperative comorbidities and to increase postoperative complications.
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Affiliation(s)
- Kaku Yoshimi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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14
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Lugg ST, Agostini PJ, Tikka T, Kerr A, Adams K, Bishay E, Kalkat MS, Steyn RS, Rajesh PB, Thickett DR, Naidu B. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax 2016; 71:171-6. [DOI: 10.1136/thoraxjnl-2015-207697] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Leuzzi G, Facciolo F, Pastorino U, Rocco G. Methods for the postoperative management of the thoracic oncology patients: lessons from the clinic. Expert Rev Respir Med 2015; 9:751-67. [DOI: 10.1586/17476348.2015.1109453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Genetic variation in the TNF/TRAF2/ASK1/p38 kinase signaling pathway as markers for postoperative pulmonary complications in lung cancer patients. Sci Rep 2015; 5:12068. [PMID: 26165383 PMCID: PMC4499815 DOI: 10.1038/srep12068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 06/10/2015] [Indexed: 11/08/2022] Open
Abstract
Post-operative pulmonary complications are the most common morbidity associated with lung resection in non-small cell lung cancer (NSCLC) patients. The TNF/TRAF2/ASK1/p38 kinase pathway is activated by stress stimuli and inflammatory signals. We hypothesized that genetic polymorphisms within this pathway may contribute to risk of complications. In this case-only study, we genotyped 173 germline genetic variants in a discovery population of 264 NSCLC patients who underwent a lobectomy followed by genotyping of the top variants in a replication population of 264 patients. Complications data was obtained from a prospective database at MD Anderson. MAP2K4:rs12452497 was significantly associated with a decreased risk in both phases, resulting in a 40% reduction in the pooled population (95% CI:0.43–0.83, P = 0.0018). In total, seven variants were significant for risk in the pooled analysis. Gene-based analysis supported the involvement of TRAF2, MAP2K4, and MAP3K5 as mediating complications risk and a highly significant trend was identified between the number of risk genotypes and complications risk (P = 1.63 × 10−8). An inverse relationship was observed between association with clinical outcomes and complications for two variants. These results implicate the TNF/TRAF2/ASK1/p38 kinase pathway in modulating risk of pulmonary complications following lobectomy and may be useful biomarkers to identify patients at high risk.
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Masuda Y, Marutsuka T, Suzuki M. A risk factor for kinked middle lobar bronchus following right upper lobectomy. Asian Cardiovasc Thorac Ann 2014; 22:955-9. [DOI: 10.1177/0218492314526396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Kinking of the middle lobar bronchus is sometimes observed after a right upper lobectomy, but prevention and treatment have not been established. This study aimed to determine the risk factors for a kinked middle lobar bronchus causing postoperative middle lobe atelectasis. Methods We performed a retrospective analysis of the medical records of 35 patients who underwent a right upper lobectomy in our hospital. Demographic and preoperative variables were compared in 4 patients with postoperative middle lobe atelectasis and kinking of the middle lobar bronchus and 31 without postoperative middle lobe atelectasis, determined by bronchoscopy and computed tomography findings. Results There were no significant differences between the two groups in terms of age, sex, body mass index, smoking status, lung function test results, or volume ratio of the right upper lobe. A shorter distance from the carina to the middle lobe orifice was the only risk factor for a kinked middle lobar bronchus identified (40.25 ± 2.45 vs. 48.06 ± 4.78 mm, p = 0.006). Conclusion A short distance from the carina to the middle lobe orifice could be a risk factor for kinking of the middle lobar bronchus in postoperative middle lobe atelectasis after right upper lobectomy.
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Affiliation(s)
- Yoshiko Masuda
- Department of Thoracic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Takashi Marutsuka
- Department of Thoracic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Makoto Suzuki
- Department of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
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Yang Y, Chen J, Zhu D, Chen G, Li Z, Li M, Wei S, Qiu X, Zhao H, Liu Y, Zhou Q. [Prevention and treatment of atelectasis after thoracotomy for lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:234-7. [PMID: 20673522 PMCID: PMC6000539 DOI: 10.3779/j.issn.1009-3419.2010.03.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 02/07/2010] [Indexed: 12/03/2022]
Abstract
背景与目的 肺不张是开胸术后的常见并发症,严重时会危及患者生命。本文旨在分析和探讨肺癌患者行开胸术后发生肺不张的原因和围手术期的预防和处理措施,以便降低肺不张的发生率,并提高其治愈率,以进一步降低围手术期死亡率。 方法 回顾性统计和分析我科因肺癌行开胸手术的374例患者中发生肺不张的资料和处理措施。 结果 374例肺癌患者行开胸手术后发生肺不张的有14例,经积极有效地治疗后肺不张的肺叶均复张。 结论 肺癌开胸术后肺不张发生率不高,有效的术前准备、良好的围术期处理和术后治疗可以降低开胸术后肺不张的发生率,提高治愈率。
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Affiliation(s)
- Yongbo Yang
- Department of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjian 300052, China
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