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Treatment of pulmonary artery stump thrombosis after lobectomy: a case report and literature review.
Wieteska-Miłek, M, Winiarczyk, K, Kupis, W
Advances in respiratory medicine. 2021;(3):311-315
Abstract
INTRODUCTION Lung cancer surgery is a well-known risk factor for venous thromboembolism. Thus, standard care involves the use of pharmacological and mechanical prophylaxis until discharge from the hospital. Pulmonary artery stump thrombosis (PAST) is a rare condition which can develop months to years after lung cancer surgery. This report describes a patient diagnosed with PAST and the decisions that were made regarding his treatment. CASE REPORT A 67-year-old male was diagnosed with lung cancer due to shortness of breath, dry cough, hemoptysis, and typical chest computed tomography (CT) findings. He underwent right lower lobectomy and mediastinal lymphadenectomy by video-assisted thoracoscopic surgery. The procedure was complicated by the development of a right pleural empyema. After pleural drainage and an antibiotic regimen, he was discharged from the hospital with further improvement. A follow-up CT pulmonary angiography performed three months after lobectomy revealed thrombosis in the right lower lobar pulmonary artery stump. The patient had no symptoms. The attending physician decided to use anticoagulants. Consequently, the patient received low molecular-weight heparin subcutaneously for one month and a non-vitamin-K antagonist oral anticoagulant (NOAC) for the following 5 months. A CT scan performed after 3 months of anticoagulation showed complete resolution of stump thrombosis. Subsequent examinations showed no recurrence of either lung cancer or artery stump thrombosis and no anticoagulant-related bleeding. DISCUSSION Pulmonary artery stump thrombosis can develop after lung cancer surgery. This complication is uncommon and the prognosis is favorable in most treated cases. However, thrombosis may progress, and pulmonary embolism or chronic thromboembolic pulmonary hypertension may develop. Decisions about instituting anticoagulation therapy and its duration are made on an individual basis after considering both the benefits and the potential risks.
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Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer?
Mimae, T, Okada, M
General thoracic and cardiovascular surgery. 2020;(7):703-706
Abstract
In 1995, Ginsberg et al. compared lobectomy with limited resection including segmentectomy and wide-wedge resection for stage I lung cancer in a randomized controlled trial and found that limited resection should not be applied to otherwise healthy patients with clinical stage IA lung cancer who can tolerate lobectomy. However, recent advances in diagnostic technology have improved the precision of detecting early-stage and small lung cancers. Therefore, whether radical segmentectomy, anatomical segmentectomy with hilar and mediastinal lymph node dissection (that is more valuable than wedge resection in terms of oncological aspects) and lobectomy are comparable in terms of curative intent for patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. The role of segmentectomy differs according to tumor or patient characteristics. High resolution computed tomography findings of tumor size, location, and the presence or ratio of a ground glass opacity (GGO) component and the maximum of standardized uptake value on fluorine-18-2-deoxy-D-glucose positron emission tomography are important for selecting surgical procedures because the malignant potential of even early-stage NSCLC is variable. The ongoing JCOG0802/WJOG4607L, JCOG1211, and CALGB140503 trials will disclose the influence of segmentectomy for patients with early-staged NSCLCs that are small peripheral tumors based on preoperative high-resolution computed tomography findings about preserved pulmonary function and long-term prognosis. Segmentectomy is a key surgical procedure that general thoracic surgeons will need to master considering that it can be converted to lobectomy if the surgical margin is insufficient or lymph node metastasis is intraoperatively confirmed.
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3.
External suction versus simple water-seal on chest drainage following pulmonary surgery: an updated meta-analysis.
Zhou, J, Chen, N, Hai, Y, Lyu, M, Wang, Z, Gao, Y, Pang, L, Liao, H, Liu, L
Interactive cardiovascular and thoracic surgery. 2019;(1):29-36
Abstract
OBJECTIVES The decision to apply simple water-seal drainage or the addition of an external suction to the simple water-seal drainage following pulmonary surgery is made based on the surgeon's experience or preference and has remained controversial. This meta-analysis aimed to assess the effects of the addition of suction to simple water-seal on the postoperative outcomes. METHODS PubMed, EMBASE and Web of Science were searched from their inception to 30 August 2017. The risk ratio and the weight mean difference were calculated for dichotomous and continuous outcomes, respectively, each with 95% confidence intervals (CIs). The heterogeneity and risk of bias were also assessed. RESULTS A total of 10 randomized controlled trials enrolling 1601 patients were included. Overall, compared with simple water-seal, the addition of external suction reduced the occurrence of postoperative pneumothorax (risk ratio 0.35, 95% CI 0.13-0.93; P = 0.04) and other cardiopulmonary complications (risk ratio 0.65, 95% CI 0.48-0.89; P = 0.008), and increased the duration of chest tube drainage (weight mean difference 0.92 days, 95% CI 0.04-1.81, P = 0.04). However, the effect difference between the 2 groups was not significant regarding air leak duration, length of hospital stay and the occurrence of prolonged air leak. The stability of these studies was strong. No evidence of publication bias was detected. CONCLUSIONS The addition of suction to simple water-seal made no difference to air leak duration, hospital stay or the occurrence of prolonged air leak following pulmonary surgery. In patients where there is concern about a residual or increasing pneumothorax, the addition of suction may be applied selectively.
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Postoperative atrial fibrillation prophylaxis after lung surgery: systematic review and meta-analysis.
Riber, LP, Larsen, TB, Christensen, TD
The Annals of thoracic surgery. 2014;(6):1989-97
Abstract
BACKGROUND Atrial fibrillation after thoracic surgery is frequent and increases morbidity and mortality. A number of trials have investigated medical prophylaxis for the prevention of atrial fibrillation after surgery for lung cancer. However, the literature is diverse and hence difficult to review. The aim of this study was to evaluate the safety and efficacy of reducing the risk of postoperative atrial fibrillation by the use of medical prophylaxis in patients undergoing surgery for lung cancer. METHODS A systematic review and meta-analysis of randomized, controlled trials investigating prophylactic medical interventions to reduce the risk of postoperative atrial fibrillation was performed. RESULTS A total number of 10 trials were identified. A significant reduction in the risk of postoperative atrial fibrillation was found with a relative risk of 0.53 (95% confidence interval, 0.42 to 0.67) and a number needed-to-treat of 8.5 (95% confidence interval, 6.4 to 13.3). Amiodarone was found to be the most effective prophylactic agent with a relative risk of 0.32 (95% confidence interval, 0.19 to 0.50) and a number needed-to-treat of 4.8 (95% confidence interval, 3.7 to 7.6) and regarded as safe, with no severe adverse events registered. The risk of atrial fibrillation was overall reduced from 25.1% to 13.4% (p < 0.001) and for amiodarone as a single therapy from 30.4% to 9.6% (p < 0.001). CONCLUSIONS Medical prophylaxis with calcium-channel blockers, magnesium sulfate, or amiodarone significantly reduces the risk of developing atrial fibrillation after lung reduction surgery. However, amiodarone and magnesium sulfate were the most effective and safest drugs causing no increased risk of adverse events.
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5.
Prophylaxis of atrial fibrillation after noncardiac thoracic surgery.
Tisdale, JE, Wroblewski, HA, Kesler, KA
Seminars in thoracic and cardiovascular surgery. 2010;(4):310-20
Abstract
Atrial fibrillation (AF) occurs commonly after noncardiac thoracic surgery, including lobectomy, pneumonectomy and esophagectomy. While not as extensively investigated as AF following cardiac surgery, some strategies for prophylaxis of AF after noncardiac thoracic surgery have been studied. Evidence from prospective, randomized controlled studies supports the use of beta-blockers, diltiazem, amiodarone or magnesium for prevention of AF after pulmonary resection. Limited evidence supports the efficacy of intravenous amiodarone for prevention of AF after esophagectomy. Further study is necessary to determine the safest and most effective methods of prophylaxis of AF after noncardiac thoracic surgery, and to identify patients most likely to benefit from AF prophylaxis.
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6.
Chronic respiratory failure after lung resection: the role of pulmonary rehabilitation.
Celli, BR
Thoracic surgery clinics. 2004;(3):417-28
Abstract
Pulmonary rehabilitation gradually has become the gold standard treatment for patients with severe lung disease, especially COPD. By definition, rehabilitation services are provided to patients with symptoms, most of whom have moderate-to-advanced lung disease. Because new therapeutic strategies, such as lung volume-reduction surgery and lung transplantation, require well-conditioned patients, pulmonary rehabilitation is becoming a crucial component of the overall treating strategy of many patients who heretofore were deemed untreatable. The positive results in several randomized trials have documented the effectiveness of pulmonary rehabilitation. Currently, pulmonary rehabilitation should be made available to all patients with symptomatic respiratory disease and be an integral part of any program considering high-risk surgery.