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Mei LY, Feng YG, Tao SL, Jiang B, Dai FQ, Zhou JH, Shen C, Guo W, Tan QY, Deng B. Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor. J Cardiothorac Surg 2022; 17:306. [PMID: 36510224 PMCID: PMC9746151 DOI: 10.1186/s13019-022-02064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In this study, we aimed to summarize the extremely important lesson and experience in the whole process of surgical treatments of lung tumors for the benefit of steps taken to prevent against unplanned reoperation. METHODS Demographical and clinical information of 7732 patients were retrospectively retrieved and reviewed, who were diagnosed with pulmonary tumor and underwent surgical treatments from January 2016 to March 2021. Those patients who underwent unplanned reoperation for the treatment of severe complications were focused carefully and analyzed meticulously. RESULTS A total of forty-one patients (41/7732) received 44 unplanned reoperations. Among them, eight and thirty-three patients were diagnosed with benign and malignant tumor, respectively. The incidence of unplanned reoperations seemed to be similar on both sides (Left vs. Right: 12/3231 vs. 29/4501, p = 0.103). Lobectomy plus segmentectomy is prone to reoperation (2/16, 12.5%) as compared to the other types of surgery. The complications leading to reoperation was hemothorax, including active hemorrhage (23/44, 52.3%) and clotted hemothorax (6/44, 13.6%), chylothorax (8/44, 18.2%), and the others (7/44, 15.9%) including bronchopleural fistula, torsion, or injury of right middle bronchus and pulmonary bulla rupture. The morbidity and mortality after unplanned reoperation were 17.1% (7/41) and 12.2% (5/41), respectively. CONCLUSIONS Bronchi or vessel stumps, the surgical edges of the lung parenchyma, and pleural adhesions should be checked to avoid postoperative bleeding. Prophylactic ligation of the thoracic duct should be recommended in case of the suspected oily-like exudation in the lymph node bed. Smooth expansion of the middle lobe is important to avoid narrowing and torsion before transection of the bronchus.
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Affiliation(s)
- Long-Yong Mei
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Yong-Geng Feng
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Shao-Lin Tao
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Bin Jiang
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Fu-Qiang Dai
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Jing-Hai Zhou
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Cheng Shen
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Wei Guo
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Qun-You Tan
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Bo Deng
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
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Ahn HY, I H. Non-conservative Management of Chylothorax. J Chest Surg 2021; 54:325-329. [PMID: 34353975 PMCID: PMC8350472 DOI: 10.5090/jcs.21.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Chylothorax is caused by lymphatic leakage, which can develop after thoracic surgery and is associated with cancer. Although prospective randomized trials have not been performed, radiological interventions have been performed in several cases with persistent chylothorax, adjunct to 2 weeks of conservative management. The success rate of such interventions is diverse due to anatomical variations, although the results are promising. However, in cases of treatment failure after cycles of interventions, a team approach may be necessary to determine whether surgical management is warranted.
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Affiliation(s)
- Hyo Yeong Ahn
- Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hoseok I
- Department of Thoracic and Cardiovascular Surgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Nakada T, Shirai S, Oya Y, Takahashi Y, Sakakura N, Ohtsuka T, Kuroda H. The impact of same-day chest drain removal on pulmonary function after thoracoscopic lobectomy. Gen Thorac Cardiovasc Surg 2020; 69:690-696. [PMID: 33123846 DOI: 10.1007/s11748-020-01516-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aims to assess the feasibility and impact on long-term pulmonary function of chest drain removal on the operation day following thoracoscopic right upper lobectomy for clinical stage I non-small cell lung cancer. METHODS We retrospectively evaluated the data of 116 patients between May 2013 and March 2019. We evaluated the correlations of clinical parameters of chest drain removal and medium- and long-term pulmonary function by comparing removal on operation day (R group) and retainment (D group). RESULTS The R group comprised 64 patients, and the D group had 52 patients. Fifty patients (96.2%) in the D group had chest drain removed within 3 postoperative days. Since February 2016, chest drain removal on operation day was performed in 64 of 74 patients (86.5%) according to our chest drain removal protocol. Removal of chest drains on operation day was associated with shorter postoperative hospitalization (p < 0.01) and lower postoperative complications ≧ grade II of the Clavien-Dindo classification (p = 0.026). Only one patient in the R group needed reinsertion. The R group had greater spirometry results at 3- and 12-postoperative months (POM). R group patients had statistically improved pulmonary functions from 3 to 12POM, while those in the D Group were stagnated at 6POM. CONCLUSIONS Removal of chest drains on operation day using our protocol is safe and feasible for thoracoscopic right upper lobectomy. This protocol was statistically associated with slightly better long-term pulmonary function, which could not bring clinically meaningful medium- and long-term benefit.
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Affiliation(s)
- Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
| | - Suguru Shirai
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Yuko Oya
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Takashi Ohtsuka
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Nishishinbashi 3-19-18, Minatoku, Tokyo, 105-8471, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
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