Complications of Surgery in the Treatment of Carcinoma of the Lung

doi:10.1378/chest.82.1.25

Chest

Volume 82, Issue 1, July 1982, Pages 25-29

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Nine hundred sixty-one patients underwent operations for the treatment of carcinoma of the long; 18 percent of these were 70 years of age or older. The effect of various factors, singly or in combination, on the incidence of postoperative complications was assessed. Variables included age, sex, cardiopulmonary status, cell type, stage of the disease, and type of procedure performed. The postoperative course was uneventful in 81 percent of the patients; 8 percent had minor complications, 9 percent major complications and 2 percent died. The majority of the complications were cardiorespiratory. High risk factors were identified to be old age, restricted cardiopulmonary reserve, and the need for pneumonectomy. The low incidence of mortality and major morbidity observed was attributed to careful preoperative evaluation, selection of the appropriate surgical procedure, and inclusion of routine preoperative physiotherapy in all patients.

Section snippets

MATERIAL AND METHODS

From 1973 to 1980 inclusive, 1,493 patients with carcinoma of the lung were seen by the Thoracic Service of Memorial Sloan-Kettering Cancer Center. Of these, 961 patients (64 percent) had thoracotomy and are the subject of this review. The median age of the surgically-treated patients was 61 years, with a range of 19 to 85 years. There were 177 patients (18 percent) who were 70 years of age or older. The overall male-to-female ratio was 2:1.

All patients were staged according to the American

RESULTS

The postoperative course was uneventful in 780 patients (81 percent), 78 patients (8 percent) had minor complications, 83 (9 percent) had major but non-fatal complications. Twenty patients (2 percent) died of postoperative complications, 17 within 30 days and three later than 30 days (33, 48 and 53 days respectively). Minor complications included atrial flutter-fibrillation in 39 patients, prolonged air leak (7–20 days) in 16 patients, wound infection in 17, deep vein thrombosis in eight,

DISCUSSION

Lung cancer has remained largely a disease treated by surgery since the vast majority of the longterm survivors are those who have been treated surgically.1, 2, 3, 4, 5 The best results are obtained when the tumor is still localized and there is no lymphatic or hematogenous metastasis.12, 13 A significant number of patients with more advanced disease also seem to be helped by surgical treatment when feasible combined with either irradiation or chemotherapy. It was not the intent of this review,

ACKNOWLEDGMENT

The authors wish to express their appreciation to Dr. Alvin H. Freiman, F.C.C.P. and Dr. Charles S. LaMonte, F.C.C.P. for their valuable comments during the preparation and review of the manuscript.

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Cited by (224)

Use of pedicled dorsal muscle flap combined with negative pressure therapy in the management of postpneumonectomy septic complications
2020, Annales de Chirurgie Plastique Esthetique
L’objectif de cette étude est de rapporter notre expérience dans la prise en charge des complications septiques survenant à la suite de chirurgie de résection pulmonaire par la mise en place d’un lambeau pédiculé de muscle grand dorsal associé à des pansements par thérapie à pression négative chez l’ensemble des patients pris en charge dans notre centre de novembre 2015 à mars 2018.
Nous avons relevé les caractéristiques de quatorze patients ayant bénéficié d’un lambeau de muscle grand dorsal pédiculé réalisé dans un contexte d’empyème chronique associé à une fistule bronchopulmonaires. Le délai de mise en place du lambeau, les complications et le taux de succès ont été évaluées.
La médiane de la mise en place du lambeau après réalisation de la thoracostomie était de 19 jours [3–65]. La médiane du délai de cicatrisation était de 3 mois. La cicatrisation a été obtenue de façon définitive chez 12 patients soit un taux de succès de 86 %.
À travers cette série nous avons montré que notre prise en charge par couverture de la cavité de pneumonectomie par un lambeau précoce de muscle grand dorsal associé à la thérapie à pression négative présente un taux de mortalité et un taux de succès similaire à ceux retrouvés au sein de la littérature.
The objective of this study is to report our experience in the management of septic complications arising from pulmonary resection surgery by placing a pedicled upper back muscle flap associated with dressings by therapy. Negative pressure in all patients supported in our center from November 2015 to March 2018.
Characteristics of fourteen patients with a pedicled dorsal muscle flap in the context of chronic empyema associated with bronchopulmonary fistula were identified. Flap placement time, complications, and success rate were assessed.
The median flap placement after completion of the open window thoracostomy was 19 days [3–65]. The median healing time was 3 months. Healing was definitively achieved in 12 patients, a success rate of 86%.
Through this series we have shown that our coverage by pneumonectomy cavity coverage with an early dorsal muscle flap associated with negative pressure therapy, has a similar mortality rate and success rate to those found in the literature.
Analyzing risk factors for morbidity and mortality after lung resection for lung cancer using the NSQIP database
2016, Journal of the American College of Surgeons
Our goal was to develop a predictive model that identifies how preoperative risk factors and perioperative complications lead to mortality after anatomic pulmonary resections.
This was a retrospective cohort study. The American College of Surgeons NSQIP database was examined for all patients undergoing elective lobectomies for cancer from 2005 through 2012. Fifty-eight pre- and intraoperative risk factors and 13 complications were considered for their impact on perioperative mortality within 30 days of surgery. Multivariate logistic regression and a logistic regression model using least absolute shrinkage and selection operator (LASSO) selection methods were used to identify preoperative risk factors that were significant for predicting mortality, either through or independent of complications. Only factors that were significant under both the multivariate logistic regression and LASSO-selected models were considered to be validated for the final model.
There were 6,435 lobectomies identified. After multivariate logistic regression modeling, 28 risk factors and 5 complications were found to be predictors for mortality. This was then tested against the LASSO method. There were 7 factors shared between the LASSO and multivariate logistic regressions that predicted mortality based on comorbidity: age (p = 0.007), male sex (p = 0.011), open lobectomy (p = 0.001), preoperative dyspnea at rest (p < 0.001), preoperative dyspnea on exertion (p = 0.003), preoperative dysnatremia (serum sodium <135 mEq/L or >145 mEq/L) (p = 0.011), and preoperative anemia (p = 0.002). Of these, 3 variables predicted mortality independent of any complications: dyspnea at rest, dyspnea on exertion, and dysnatremia.
The clinical factors that predict postoperative complications and mortality are multiple and not necessarily aligned. Efforts to improve quality after anatomic pulmonary resections should focus on mechanisms to address both types of adverse outcomes.
Venous thromboembolism in patients undergoing operations for lung cancer: A systematic review
2014, Annals of Thoracic Surgery
The risk of venous thromboembolism is perceived to be high in patients with lung cancer. However, existing studies in patients undergoing operations for lung cancer draw inconsistent conclusions and recommendations in terms of thromboprophylaxis. The aim of this study was to perform a systematic review of the risk of perioperative and postoperative venous thromboembolism for patients undergoing potential curative surgical procedures for primary lung cancer
This was a systematic review including studies of patients with primary lung cancer undergoing operations with curative intent.
We included 19 studies with a total of 10,660 patients. All studies, except 1, were observational in design. Marked heterogeneity was found between the studies in terms of methodologic aspects, patient characteristics, and findings. The mean risk of venous thromboembolism (VTE) was estimated at 2.0 % (range, 0.2%–19%), with a mean observation period of 16 months (range, 0.1–22), and the risk was nearly identical in studies with 1 month of follow-up and studies with a longer follow-up.
The evidence for using thromboprophylaxis after lung cancer operations is relatively sparse, and the use is based predominantly on clinical consensus. However, the risk of VTE seems to occur predominantly within the initial postoperative period, and subsequently the risk falls. Future research should focus on identifying patients and surgical procedures that increase the risk of VTE. This could be accomplished by large observational studies in addition to randomized controlled trials evaluating different thromboprophylaxis strategies.
Prevalence of venous thromboembolism in elective thoracic surgery
2013, Archivos de Bronconeumologia
El objetivo de este estudio es determinar la prevalencia de la enfermedad tromboembólica venosa (ETV) en pacientes sometidos a intervenciones quirúrgicas torácicas programadas bajo un protocolo de profilaxis antitrombótica y determinar el riesgo de tromboembolismo pulmonar (TEP) en pacientes con resección pulmonar anatómica, comparando los casos de lobectomía y neumonectomía.
Estudio descriptivo retrospectivo transversal en el que se incluyeron 6.004 pacientes sometidos a intervenciones quirúrgicas programadas en nuestro centro y que recibieron profilaxis antitrombótica según protocolo. Los pacientes fueron distribuidos en grupos en función del riesgo trombótico en bajo, moderado, alto y muy alto. Se calculó la prevalencia de ETV, trombosis venosa profunda (TVP) y TEP en cada grupo y la odds ratio de TEP en los grupos de pacientes con neumonectomía y lobectomía.
Once pacientes presentaron ETV (0,18%). La edad media de estos pacientes fue de 65,95 años, el 90,9% tenían un diagnóstico de neoplasia y esta complicación fue más frecuente en neumonectomía (45,45% de los casos de ETV). El 80,8% de los pacientes presentaban un riesgo alto de ETV y el 100% de los casos de ETV se dio en pacientes de alto riesgo (0,23%). La odds ratio de ETV fue de 4,6 comparando los casos de neumonectomía y lobectomía.
La prevalencia de ETV en esta serie, en la que se ha seguido una pauta estandarizada de profilaxis, es de 0,18% (1,31% en pacientes neumonectomizados). Estas cifras pueden ser utilizadas como valores de referencia en cirugía torácica.
The aim of this study was to determine the prevalence of venous thromboembolism (VTE) after elective thoracic surgery in patients receiving antithrombotic prophylaxis, and to evaluate the risk of pulmonary embolism (PE) after lung resection.
A descriptive, cross-sectional, retrospective study was designed. A total of 6004 patients were included. All patients underwent elective thoracic surgery. Prophylactic antithrombotic therapy was standardised in all cases. Patients were divided into four groups (low, moderate, high and very high) according to their thrombotic risk. The prevalence of VTE, deep vein thrombosis and PE in each group was calculated. The odds of PE for pneumonectomy was also calculated and compared to lobectomy.
Eleven patients (0.18%) had postoperative VTE. The mean age of this subset was 65.95 years; 90.9% were diagnosed with malignant neoplasm. Some 80.8% of patients in the series and all VTE cases were included in the high risk VTE group. VTE was more common in pneumonectomy (45.45% of VTE cases, odds ratio 4.6 compared to lobectomy).
The prevalence of VTE in this series was 0.18% (1.31% in pneumonectomy patients). These figures could serve as reference values for thromboembolic disease in general thoracic surgery.
Physiotherapy in thoracic surgery
2013, Tidy's Physiotherapy: Fifteenth Edition
Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology. A Case-Based Overview
2012, Anesthesiology Clinics

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This work was supported in part by the David B. Kriser Lung Cancer Task Force Fund.

Manuscript received January 18; revision accepted February 13.

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Clinical InvestigationsComplications of Surgery in the Treatment of Carcinoma of the Lung

Section snippets

MATERIAL AND METHODS

RESULTS

DISCUSSION

ACKNOWLEDGMENT

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Am J Surg

J Thorac Cardiovasc Surg

Chest

Chest

Am J Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg.

J Thorac Cardiovasc Surg

Ann Thorac Surg

Chest

Clinical Investigations
Complications of Surgery in the Treatment of Carcinoma of the Lung