Postoperative complications after thoracic surgery for lung cancer

Imaging findings of the postoperative chest: What the radiologist should know

Thoracic surgical procedures are increasing in recent years, and there are different types of lung resections. Postsurgical complications vary depending on the type of resection and the time elapsed, with imaging techniques being key in the postoperative follow-up. Multidisciplinary management of these patients throughout the perioperative period is essential to ensure an optimal surgical outcome. This pictorial review will review the different thoracic surgical techniques, normal postoperative findings and postsurgical complications.

Shortness of breath on the day of discharge: an early alert for post-discharge complications in patients undergoing lung cancer surgery

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.

Unveiling the Effects of the COVID-19 Pandemic on Lung Cancer Surgery

The aim of this study is to investigate the impact of the COVID-19 pandemic on the surgical treatment of lung cancer patients. Data from patients who underwent surgery during the pandemic were analyzed and compared to pre-pandemic and post-pandemic periods. Multiple parameters were examined, and their changes yielded significant results compared to other periods of the study. The statistical analysis revealed a significant decrease in the number of surgical interventions during the pandemic (p < 0.001), followed by a significant rebound thereafter. During this period, there was a significant increase in the T stage of cancer compared to both pre-pandemic and post-pandemic periods (p = 0.027). Additionally, the mean Charlson comorbidity index score was significantly higher during the pandemic compared to the pre-pandemic period (p = 0.042). In this crisis period, a significant decrease was recorded in both the total hospitalization duration (p = 0.015) and the pre-operative hospitalization duration (p = 0.006). These findings provide evidence of significant changes in clinical and therapeutic strategies applied to lung cancer surgery patients during the study period. The pandemic has had a substantial and complex impact, the full extent of which remains to be fully understood.

Effects of mindful breathing training combined with diary-based rehabilitation guidance in lung cancer patients undergoing surgery: A randomized controlled trial

BACKGROUND AND PURPOSE

Lung cancer surgery patients experience severe physical and mental symptoms, which seriously affect their quality of life and prognosis. Mindful breathing training is a promising strategy to improve their symptoms, but its effectiveness is affected by training compliance, and diary-based rehabilitation instruction has been shown to help improve training compliance. Therefore, the aim of this study was to evaluate the effects of mindful breathing training combined with diary-based rehabilitation guidance on improving perioperative outcomes in lung cancer surgery patients.

MATERIALS AND METHODS

This single-center, assessor-blinded, prospective, three-arm randomized controlled trial was conducted from November 1, 2021 to November 1, 2022. Patients diagnosed with primary non-small cell lung cancer and scheduled for thoracoscopic surgery were randomly allocated to the combined intervention group, the mindful breathing group or the control group, with 34 patients in each group. The control group received routine care, while the mindful breathing group received mindful breathing training and routine care. The combined intervention group received both mindful breathing training and diary-based rehabilitation guidance, along with routine care.

RESULTS

The per-protocol analysis revealed that patients in the mindful breathing group experienced statistically significant improvements in dyspnea, fatigue and anxiety. Patients in the combined intervention group had statistically significant improvements in dyspnea, fatigue, anxiety, depression, exercise self-efficacy and training compliance.

CONCLUSION

This study provides evidence that mindful breathing training combined with diary-based rehabilitation guidance can be effective in improving perioperative outcomes in lung cancer patients. It can be applied in clinical practice in the future.

Rivaroxaban versus nadroparin for thromboprophylaxis following thoracic surgery for lung cancer: A randomized, noninferiority trial

The benefit of rivaroxaban in thromboprophylaxis after oncologic lung surgery remains unknown. To evaluate the efficacy and safety of rivaroxaban, patients who underwent thoracic surgery for lung cancer were enrolled, and randomly assigned to rivaroxaban or nadroparin groups in a 1:1 ratio; anticoagulants were initiated 12-24 h after surgery and continued until discharge. Four hundred participants were required according to a noninferiority margin of 2%, assuming venous thromboembolism (VTE) occurrence rates of 6.0% and 12.6% for patients in the rivaroxaban and nadroparin groups, respectively. The primary efficacy outcome was any VTE during the treatment and 30-day follow-up periods. The safety outcome was any on-treatment bleeding event. Finally, 403 patients were randomized (intention-to-treat [ITT] population), with 381 included in per-protocol (PP) population. The primary efficacy outcomes occurred in 12.5% (25/200) of the rivaroxaban group and 17.7% (36/203) of the nadroparin group (absolute risk reduction, -5.2%; 95% confidence interval [CI], [-12.2-1.7]), indicating the noninferiority of rivaroxaban in ITT population. Sensitivity analysis was performed in the PP population and yielded similar results, confirming the noninferiority of rivaroxaban. In the safety analysis population, the incidence of any on-treatment bleeding events did not differ significantly between the groups (12.2% for rivaroxaban vs. 7.0% for nadroparin; relative risk [RR], 1.9; 95% CI, [0.9-3.7]; p = .08), including major bleeding (9.7% vs. 6.5%; RR, 1.6 [95% CI, 0.9-3.7]; p = .24), and nonmajor bleeding (2.6% vs. 0.5%; RR, 5.2 [95% CI, 0.6-45.2]; p = .13). Rivaroxaban for thromboprophylaxis after oncologic lung surgery was shown to be noninferior to nadroparin.

Carinal sleeve resections

Carinal resections are frequently performed for carinal tumors. Resection of the carina due to distal tracheal tumors may be required, and the extension of main bronchial tumors to the carina may lead to carinal resection. This is one of the rarely performed operations in thoracic surgery, which is technically challenging and has a high complication rate. In the early series, perioperative mortality rate was reported as 29% and the five-year survival rate as 15%. Due to its technical difficulties and high complication rates, it is performed only in certain centers. In this review, we discuss techniques related to carinal sleeve resection and prognostic factors in the light of literature data.

Clinical Indicators of Effects of Yoga Breathing Exercises on Patients With Lung Cancer After Surgical Resection: A Randomized Controlled Trial

BACKGROUND

Cancer itself and surgery pose a heavy burden on adults with lung cancer. Yoga breathing exercises have been proposed as a form of pulmonary rehabilitation exercises to improve these patients' perioperative outcomes.

OBJECTIVE

To investigate the impact of yoga breathing exercises based on a problem-solving model on dyspnea, exercise capacity, anxiety, depression, and postoperative indwelling time of thoracic drainage tube and compliance in adults with lung cancer undergoing surgery.

METHODS

One hundred eight lung cancer patients were randomly assigned to receive problem-solving model-based yoga breathing exercises, yoga breathing exercises, or usual care. Outcomes were collected at admission, the day before surgery, and at discharge.

RESULTS

Patients in the combined intervention group showed a significantly greater improvement in dyspnea, exercise capacity, and anxiety compared with the control group. Yoga breathing training can significantly improve patients' dyspnea and anxiety. Significant difference favoring the combined group was observed in exercise capability and compliance between the 2 intervention groups. However, there was no significant difference in depression or indwelling time of thoracic drainage tube among the 3 groups at any time point.

CONCLUSION

Findings indicate that yoga breathing exercises are effective in alleviating perioperative symptoms of lung resection patients. Compared with yoga breathing exercises, applying additional problem-solving model may achieve a better effect.

IMPLICATIONS FOR PRACTICE

Yoga breathing exercises can be considered as a promising pulmonary rehabilitation strategy for lung cancer patients with surgery. The problem-solving model could be integrated into yoga breathing exercises in clinical practice to enhance the rehabilitation effect.

Postoperative empyema complicated with descending necrotizing fasciitis: a case report

Background

Empyema is a serious complication of lung surgery.

Case presentation

We report a case of Streptococcus anginosus empyema complicated by descending necrotizing fasciitis after surgery. Ten days after the initial surgery, the patient presented with arrhythmia and hypotension with septic shock. Pleural fluid analysis led to the diagnosis of empyema, and surgical debridement (second surgery) was performed. One week after the emergency surgery, a palpable pink erythematous skin change was observed on the ipsilateral iliac crest. Hence, the second emergency surgery (third surgery) was performed to debride the subcutaneous and intramuscular abscesses.

Conclusions

The possibility of descending abscess and necrotizing fasciitis should be considered when Streptococcus anginosus is detected.

A Hybrid Method to Predict Postoperative Survival of Lung Cancer Using Improved SMOTE and Adaptive SVM

Predicting postoperative survival of lung cancer patients (LCPs) is an important problem of medical decision-making. However, the imbalanced distribution of patient survival in the dataset increases the difficulty of prediction. Although the synthetic minority oversampling technique (SMOTE) can be used to deal with imbalanced data, it cannot identify data noise. On the other hand, many studies use a support vector machine (SVM) combined with resampling technology to deal with imbalanced data. However, most studies require manual setting of SVM parameters, which makes it difficult to obtain the best performance. In this paper, a hybrid improved SMOTE and adaptive SVM method is proposed for imbalance data to predict the postoperative survival of LCPs. The proposed method is divided into two stages: in the first stage, the cross-validated committees filter (CVCF) is used to remove noise samples to improve the performance of SMOTE. In the second stage, we propose an adaptive SVM, which uses fuzzy self-tuning particle swarm optimization (FPSO) to optimize the parameters of SVM. Compared with other advanced algorithms, our proposed method obtains the best performance with 95.11% accuracy, 95.10% G-mean, 95.02% F1, and 95.10% area under the curve (AUC) for predicting postoperative survival of LCPs.

Surgery for lung cancer: postoperative changes and complications-what the Radiologist needs to know

Imaging findings after thoracic surgery can be misleading. Knowledge of the normal post-operative anatomy helps the radiologist to recognise life-threatening complications and conversely not to wrongly evoke a complication in cases of trivial post-operative abnormalities. In this educational article, we reviewed the expected patterns after thoracic surgery including sublobar resection, lobectomy, pneumonectomy and related techniques. Imaging aspects of frequent and less common complications and their typical imaging features are then presented.

AAAPT Diagnostic Criteria for Acute Thoracic Surgery Pain

Patients undergoing thoracic surgery experience particular challenges for acute pain management. Availability of standardized diagnostic criteria for identification of acute pain after thoracotomy and video assisted thoracic surgery (VATS) would provide a foundation for evidence-based management and facilitate future research. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership with the United States Food and Drug Administration, the American Pain Society (APS), and the American Academy of Pain Medicine (AAPM) formed the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) initiative to address absence of acute pain diagnostic criteria. A multidisciplinary working group of pain experts was invited to develop diagnostic criteria for acute thoracotomy and VATS pain. The working group used available studies and expert opinion to characterize acute pain after thoracotomy and VATS using the 5-dimension taxonomical structure proposed by AAAPT (i.e., core diagnostic criteria, common features, modulating factors, impact/functional consequences, and putative mechanisms). The resulting diagnostic criteria will serve as the starting point for subsequent empirically validated criteria. PERSPECTIVE ITEM: This article characterizes acute pain after thoracotomy and VATS using the 5-dimension taxonomical structure proposed by AAAPT (ie, core diagnostic criteria, common features, modulating factors, impact and/or functional consequences, and putative mechanisms).

The postoperative chest in lung cancer

Most of the complications following lung cancer surgery occur in the early postoperative period and can result in significant morbidity and mortality. Delayed complications can also occur. Diagnosing these complications can be challenging because clinical manifestations are non-specific. Imaging plays an important role in detecting these complications in a timely manner and facilitates prompt interventions. Hence, it is important to have knowledge of the expected anatomical alterations following lung cancer surgeries, and the spectrum of post-surgical complications and their respective imaging findings to avoid misinterpretations or delay in diagnosis.

Rehabilitation for lung cancer patients undergoing surgery: results of the PUREAIR randomized trial

BACKGROUND

Surgery for Non Small Cell Lung Cancer is proven to be the most effective treatment in early stages, although concerns exist on its negative impact on patients' overall fitness.

AIM

To establish whether intensive pulmonary rehabilitation, preoperative and postoperative, improves exercise capacity in patients undergoing lung resection.

DESIGN

Single centre, unblinded, designed for superiority, 1:1 randomised controlled trial with two parallel arms.

SETTING

S.Maria Nuova Hospital of Reggio Emilia (Italy).

POPULATION

Patients referred from local lung cancer multi-disciplinary team for lung resection.

METHODS

Patients were randomised to either standard of care (SC) or SC + intensive perioperative pulmonary rehabilitation (SC+PR). The primary aim was to investigate the effectiveness of pulmonary rehabilitation in improving exercise capacity six months after surgery. Additionally, we wanted to investigate the same effect shortly after surgery (at one month), as well as the overall impact of rehabilitation on lung function, postoperative complications and length of stay, Quality of Life, mood disturbances and pain. Sample was sized based on the primary outcome assuming a minimal clinically significant difference of 25 metres in exercise tolerance, measured with 6 minutes walking test.

RESULTS

The exercise tolerance at 6 months after surgery was significantly higher in patients undertaking PR compared to SC (+48.9 metres vs -7.5 metres respectively, difference: +56.4 metres, 95% CI: 29.6 - 83.0, p<0.001) and it showed significantly lower impairment at 1 month after surgery in the intervention group (-3.0 metres vs -30.1 metres difference: +27.1 metres, 95% CI: 3.4 - 50.8, p=0.025). No other significant differences between groups were found.

CONCLUSIONS

Comparison between groups showed that pulmonary rehabilitation, administered pre and postoperatively, significantly improved exercise capacity at 6 months in patients undergoing lung resection; it also significantly reduced the decrease in exercise tolerance observed 1 month after surgery.

CLINICAL REHABILITATION IMPACT

The PUREAIR trial highlights the importance of combined pre-operative and post-operative rehabilitation in reducing physical deconditioning in lung cancer patients undergoing surgery. Comprehensive pulmonary rehabilitation improves exercise capacity at 1 and 6 months after surgery. The PUREAIR trial results increase knowledge on comprehensive rehabilitation's outcomes in the first six months after surgery.

Small RNA sequencing to differentiate lung squamous cell carcinomas from metastatic lung tumors from head and neck cancers

Distinguishing lung squamous cell carcinoma (LSQCC) from a solitary metastatic lung tumor (MSQCC) from head and neck squamous cell carcinoma (HNSQCC) presents a difficult diagnostic challenge even after detailed pathological assessment. Treatment options and estimated survival outcomes after pulmonary resection differ between patients with LSQCC and MSQCC. This study aimed to investigate whether microRNA (miRNA) profiling by RNA sequencing of HNSQCC, MSQCC, and LSQCC was useful for differential diagnosis of MSQCC and LSQCC. RNA sequencing was performed to identify bioinformatically significant miRNAs from a formalin-fixed paraffin-embedded (FFPE) block from a derivation set. MiRNA levels were confirmed by validation sets using FFPE samples and serum extracellular vesicles from patients. Step-wise discriminant analysis and canonical discriminant analysis identified 13 miRNAs by which the different expression patterns of LSQCC, MSQCC, and HNSQCC groups were demonstrated. Six miRNAs (miR-10a/28/141/320b/3120) were assessed in validation sets, and 4 miRNAs (miR-10a/28/141/3120) were significantly upregulated in LSQCCs compared with MSQCCs and HNSQCCs. Serum extracellular vesicles from LSQCC patients demonstrated significantly elevated miR-10a (p = .042), miR-28 (p = .041), and miR-3120 (p = .047) levels compared with those from MSQCC patients. RNA sequencing is useful for differential diagnosis of LSQCC and MSQCC, and the expression level of miR-10a, miR-28, and miR-3120 in serum extracellular vesicles are promising noninvasive tools for this purpose.

Relationship between Oral Health Status and Postoperative Fever among Patients with Lung Cancer Treated by Surgery: A Retrospective Cohort Study

A retrospective observational study using an oral bacteria counter was conducted to evaluate the trends in the number of oral bacteria in the perioperative period of lung cancer patients and to verify the relationship between oral health status and postoperative fever. All patients received perioperative oral management (POM) by oral specialists between April 2012 and December 2018 at Kagawa Prefectural Central Hospital, Kagawa, Japan prior to lung cancer surgery. Bacteria counts from the dorsum of the tongue were measured on the day of pre-hospitalization, pre-operation, and post-operation, and background data were also collected retrospectively. In total, 441 consecutive patients were enrolled in the study. Bonferroni’s multiple comparison test showed significantly higher oral bacteria counts at pre-hospitalization compared to pre- and post-operation (p < 0.001). Logistic regression analysis showed that body mass index, performance status, number of housemates, number of teeth, and white blood cell count at pre-operation were significantly associated with postoperative fever. The study showed that POM can reduce the level of oral bacterial counts, that the risk of postoperative complications is lower with dentulous patients, and that appropriate POM is essential for prevent of complications. Therefore, POM may play an important role in perioperative management of lung cancer patients.

Implementation of a pulmonary thromboembolism prophylaxis program in Chinese lung surgery patients: compliance and effectiveness

Background

Most studies on prophylaxis against pulmonary embolism (PE) after lung surgery have come from the West. Whether such prophylactic programs can be successfully developed in China has not been fully studied.

Methods

A prospective observational trial included 581 Chinese patients receiving lung resection surgery between August 8 and September 12 of 2017. The Caprini score was assessed on the first postoperative day (POD1). For PE prophylaxis, patients with a low score (0-4, n=55) received early ambulation, and those with a high score (≥5, n=526) received early ambulation combined with low-molecular weight heparin (LMWH) injection. PE incidence and the compliance with this protocol was recorded.

Results

Three patients (0.52%) developed PE and all 3 were in the high-risk group, but LMWH was not given (non-compliance). Within the non-compliance patients (n=275), the incidence of PE was 1.09%, higher than that in the compliance patients (0%). The rate of non-compliance with the program was 47.3% (275/581) in the entire cohort. The factors associated with non-compliance were: extended lobectomy performed (9.2% vs. 1.0%, P<0.001); higher volume of postoperative chest drainages (278 vs. 239 mL, P=0.028). The non-compliance group had longer duration of ICU stay (mean of 1.3 vs. 1.1 days, P<0.001); and longer overall hospital stay (mean of 9.7 vs. 8.5 days, P<0.001).

Conclusions

Developing a PE prophylaxis program for patients receiving lung surgery in China contributed to lowering the risk of PE. Failure of compliance in patients with high risk for PE after lung surgery may be linked to worse outcomes.

A case report with COVID-19 during perioperative period of lobectomy

RATIONALE

Currently, COVID-19 has made a significant impact on many countries in the world. However, there have been no reported cases of pulmonary lobectomy with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) infection. We are the first to report such a case.

PATIENT CONCERNS

We report a 63-year-old Wuhan male patient with smoking history of 40 cigarettes per day for 40 years. He sought medical consultation for right lower lung nodules found by CT scan.

DIAGNOSES AND INTERVENTIONS

The patient's postoperative pathological diagnosis was squamous cell carcinoma of the right lower lung. On the fourth day after the operation, the real-time reverse transcription polymerase chain reaction test showed a positive result. After the operation, we routinely give symptomatic treatments such as anti-infection, nebulization and oxygen inhalation. We also change antibiotics several times depending on the patient's condition.

OUTCOMES

The patient's condition continued to deteriorate. On the fifth day after surgery, the patient died despite medical treatment.

LESSONS

We are the first to report the diagnosis and treatment process of patients with COVID-19 during perioperative period of lobectomy. It provides a case for the postoperative management of such patients.

Perioperative Factors for Predicting the Need for Postoperative Intensive Care after Major Lung Resection

Postoperative management after major lung surgery is critical. This study evaluates risk factors for predicting mandatory intensive care unit (ICU) admission immediately after major lung resection. We retrospectively reviewed patients for whom the surgeon requested an ICU bed before major lung resection surgery. Patients were classified into three groups. Univariable and multivariable logistic regression analyses were performed, and a clinical nomogram was constructed. Among 340 patients, 269, 50, and 21 were classified into the no need for ICU, mandatory ICU admission, and late-onset complication groups, respectively. Predictive postoperative diffusion capacity of the lung for carbon monoxide (47.2 (interquartile range (IQR) 43.3–65.7)% versus vs. 67.8 (57.1–79.7)%; p = 0.003, odds ratio (OR) 0.969, 95% confidence interval (CI) 0.95–0.99), intraoperative blood loss (400.00 (250.00–775.00) mL vs. 100.00 (50.00–250.00) mL; p = 0.040, OR 1.001, 95% CI 1.000–1.002), and open thoracotomy (p = 0.030, OR 2.794, 95% CI 1.11–7.07) were significant predictors for mandatory ICU admission. The risk estimation nomogram demonstrated good accuracy in estimating the risk of mandatory ICU admission (concordance index 83.53%). In order to predict the need for intensive care after major lung resection, preoperative and intraoperative factors need to be considered.

Imaging findings of complications after thoracic surgery

Many surgical procedures are used for the treatment of lung, heart, and mediastinal diseases. The techniques can result in postoperative complications. The nature of these complications differs according to the duration of thoracic surgery and the onset of the complication. The complications occurring within 1 month and more than 1 month generally considered as early and late complications, respectively. Chest radiographs and CT scans obtained in patients who have undergone thoracic surgery show normal changes during the surgical procedure and diverse postsurgical complications. Familiarity with the clinical and radiologic findings of the normal alterations and possible complications after thoracic surgery is crucial in minimizing the increased morbidity and mortality.

Modifiable risk factors for patients undergoing lung cancer surgery and their optimization: a review

Enhanced recovery after surgery (ERAS) programs include a variety of pre-, intra- and post-operative interventions that seek to decrease the stress response to surgery and facilitate the recovery of surgical patients. There are a number of patient factors that may increase the risk of postoperative complications (POC) after lung cancer surgery and delay recovery. Some of these factors may be amenable to optimization preoperatively and potentially decrease the incidence of these complications. We have chosen to discuss the incidence and complications associated with factors we felt were both relatively common and significant contributors to POCs. For each of these factors we discuss potential avenues for optimization and the evidence for the resulting decrease in complications.

Prophylactic air-extraction strategy after thoracoscopic wedge resection

Background

Since the conception of enhanced recovery after surgery protocols, tubeless strategies have become popular. Herein, we introduce a previously unreported alternative air‐extraction strategy for patients who have undergone thoracoscopic wedge resection and explore its feasibility and safety.

Methods

Between January 2015 and June 2017, 264 consecutive patients underwent thoracoscopic wedge resection with different drainage strategies. Patients were divided according to the postoperative drainage strategies used: routine chest tube drainage (RT group), complete omission of chest tube drainage (OT group), and prophylactic air‐extraction catheter insertion procedure (PC group). Using the propensity score matching method, clinical parameters and objective operative qualities were compared among the three groups.

Results

Optimal 1:1 matching was used to form pairs of RT (n =36) and PC (n =36) groups and balance baseline characteristics among the three groups. The incidence rates of pneumothorax were 5.6% (2/36), 9.8% (5/51), and 19.4% (7/36) in the RT, OT, and PC groups, respectively (P = 0.07). Chest tube reinsertion incidence for postoperative pneumothorax was 19.4% (1/7) in the PC group and 60% (3/5) in the OT group. Other postoperative complications were comparable among these groups.

Conclusions

The prophylactic air‐extraction strategy may be an alternative procedure for selected patients. Remedial air extraction may reduce the occurrence of chest tube reinsertion for pneumothorax patients, but further investigation is required.

Reoperation for hemostasis within 24 hours can get a better short-term outcome when indicated after lung cancer surgery

Background

Postoperative hemorrhage after lung cancer surgery is a potentially fatal complication. This study aimed to investigate the indications and timing of reoperation for postoperative hemorrhage after lung cancer surgery.

Methods

We identified all patients who underwent lung resection and mediastinal lymph node dissection for lung cancer between October 2001 and September 2015 at Sichuan Cancer Hospital, identifying 57 who had undergone reoperation for hemostasis. The records of these 57 patients were reviewed and analyzed.

Results

The most common postoperative hemorrhage site was the separation surface of the original pleural adhesions (29.8%). The median time interval between the initial operation and reoperation was 12 hours (range, 2-432 hours), and most patients (77.2%) underwent reoperation within 24 hours. The overall morbidity and mortality rates of reoperation were 50.9% and 5.3%, respectively. The morbidity rates of the early reoperation group (≤24 hours) and the late reoperation group were 43.2% and 77.0%, respectively, which were significantly different (P=0.033). The mortality rates of the early reoperation group and the late reoperation group were 0 and 23.1%, respectively, which were also significantly different (P=0.010).

Conclusions

Once indications of reoperation for postoperative hemorrhage after lung cancer surgery are identified, reoperation within 24 hours after the initial operation can get a better short-term outcome.

Overview of treatment related complications in malignant pleural mesothelioma

Malignant pleural mesothelioma (MPM) is an aggressive malignant neoplasm of the pleura related to asbestos exposure. Despite recent advances in therapy for MPM, the prognosis remains poor, with considerable treatment associated morbidity. Radiological assessment plays a central role in the timely identification and subsequent management of treatment related complications in MPM. This review highlights common and uncommon complications associated with and encountered in the post treatment phase.