Lou Y, Zhang Y, Wang Z, Zhao C, Li Z, Huang Q, Tang H, Xiao J. Large pneumothorax following thoracic and lumbar tumor surgery: Risk factors and management strategies.
Front Surg 2023;
10:1066841. [PMID:
36778648 PMCID:
PMC9909098 DOI:
10.3389/fsurg.2023.1066841]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Objective
Large pneumothorax is a rare but dangerous complication following thoracic and lumbar tumor surgery. There is little discussion about the features of large pneumothorax following spinal tumor surgery. The purpose of this study was to analyze the characteristics of postoperative pneumothorax, identify factors related to large pneumothorax, and propose a management algorithm for prevention, diagnosis, and treatment.
Methods
Included in this retrospective study were 118 patients who developed pneumothorax after receiving thoracic and lumbar tumor surgery between January 2015 and October 2021. A measurement of lung compression ≥20% on chest CT or x-ray was defined as large pneumothorax, and potential risk factors for large pneumothorax were identified by univariate analysis.
Results
Spinal tumor history and intraoperative blood loss were risk factors for large pneumothorax. The common symptoms of postoperative pneumothorax were chest pain, chest tightness and dyspnea. The mean longest transverse diameter of tumors was 6.63 ± 2.4 cm. En bloc resection was performed in 70 patients, with a mean operation time of 6.9 ± 2.5 h and mean intraoperative blood loss of 1771 ± 1387 ml. The most common pathologies were chondrosarcoma, giant cell tumors of bone, and neurogenic tumors.
Conclusion
During surgery, an artificial dura mater patch and a prolene suture can be used to repair the pleural and lung defects. We recommend chest CT as the preferred method for identifying postoperative pneumothorax. If a patient presents severe dyspnea, a large pneumothorax or concurrent pleural effusion, application of chest drainage is strongly recommended.
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