Is left upper lobectomy for lung cancer a risk factor for cerebral infarction?

Yamamoto, Tatsuya; Suzuki, Hidemi; Nagato, Kaoru; Nakajima, Takahiro; Iwata, Takekazu; Yoshida, Shigetoshi; Yoshino, Ichiro

doi:10.1007/s00595-015-1233-0

Cited by 72 publications

(80 citation statements)

References 20 publications

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“…Yamamoto et al [1] reported no relationship between operative time and the risk of cerebral infarction. However, increased operative time indicates increased time in the lateral position, thereby increasing the risk of cerebral infarction.…”

Section: Discussionmentioning

confidence: 98%

“…After lobectomy, the length of the left superior PV stump is longer than that of any other PV stump. Yamamoto et al [1] reported six cases of cerebral infarction out of 562 lobectomies for lung cancer, including five patients who underwent LUL. Hattori et al [6] reported 10 patients with cerebral infarction out of 1670 patients who underwent lobectomy or more intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral infarction occurs at a high frequency in patients undergoing left upper lobectomy (LUL) for lung cancer [1][2][3][4][5][6]. Thrombus caused by a long pulmonary vein (PV) stump is associated with an increased risk of cerebral infarction [1,[4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Infarction After Lobectomy for Lung Cancer

Miura¹,

Miura²,

Honda³

2019

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Background and objective: The left upper lobectomy as treatment for lung cancer has been identified as a risk factor for cerebral infarction. We analyzed cases of surgery for lung cancer to clarify factors that increase the risk for postoperative cerebral infarction. Methods: This study included patients with primary lung cancer who underwent lobectomy or segmentectomy with >ND1 lymph node dissection from 2008 to 2014 at Hachioji Medical Center of Tokyo Medical University. In total, 479 patients (294 males and 157 females) were examined. Cases of cerebral infarction occurring within 30 days of surgery were retrospectively studied. All surgeries were performed under mini-thoracotomy with thoracoscopy support. Vessels >7 mm in diameter were amputated using a linear stapler. Results: Cerebral infarction occurred in four male patients, representing 0.8% (4/479) of all lung cancers and 1.4% (4/294) of all male patients. Of these four patients, three were in their 60s (1.4% of 157 patients in their 60s) and one was in his 70s (0.5% of 215 patients in their 70s). Two cases involved adenocarcinomas, and two involved squamous cell carcinomas. One patient underwent right upper lobectomy, two underwent right lower lobectomy, and one underwent left upper lobectomy. The cerebral infarctions occurred in a branch of the vertebral artery. The pons was impaired in three cases, and the cerebellum was impaired in one. Three patients had pl2 disease, and one patient had pl3 disease. Operative time was 4-5 h in two cases, 5-6 h in one, and >6 h in one. Only pl factor significantly differed between patients with and without postoperative cerebral infarction. Conclusions: To prevent cerebral infarction, the following factors should be considered: preoperative smoking cessation, operative positioning to protect the vertebral artery, shortening of operative time, and stronger anticoagulant therapy for high-risk patients, such as those with past history of transient ischemic attack.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Cerebral Infarction After Lobectomy for Lung Cancer

Miura¹,

Miura²,

Honda³

2019

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“…PVT may be a much more common complication after LUL than previously assumed; however, an effective method of preventing it has yet to be established. Thromboembolic events associated with PVT can be life-threatening, and a retrospective study found that the rate of cerebral infarction was extremely high, especially after LUL (3,17). Thromboembolic events have deleterious effects on the outcome after surgery (18).…”

Section: Discussionmentioning

confidence: 99%

Pulmonary vein stump thrombosis after left pneumonectomy, diagnosed based on a high plasma D-dimer level: a case report

et al. 2017

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A 69-year-old man with locally advanced squamous cell lung cancer in the left hilum underwent left upper sleeve lobectomy following neoadjuvant chemoradiotherapy with an S-1/cisplatin regimen. On postoperative day (POD) 5, the chest X-ray findings deteriorated, and computed tomography (CT) images showed pulmonary congestion of the left residual lung. We then performed emergent left completion pneumonectomy. Although the Postoperative course after re-operation was uneventful, and the patient was scheduled to be discharged on POD 12 when the serum creatinine level and plasma D-dimer level increased to 1.34 mg/dL and 17.4 μg/mL respectively. CT images revealed a giant thrombus in the left superior pulmonary vein (LSPV) stump, and we immediately started anticoagulant therapy of apixaban at 10 mg/day.We confirmed that the thrombus was reduced in size on POD 30, and the patient was discharged without any further complications. The elevated plasma D-dimer level was a key finding in this case for diagnosing pulmonary vein stump thrombosis (PVT) after left lung surgery. The 23 reported cases of PVT were found incidentally through follow-up CT scan or after serious complications occurred. This is the first case reporting the utility of the plasma D-dimer test for diagnosing PVT after surgical resection of the left lung.Early detection of PVT by a plasma D-dimer test may therefore positively contribute to better outcomes in the postoperative course of surgical resection of the left lung.

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“…There are several recent reports that left upper lobe (LUL) lobectomy is a risk factor for the development of postoperative cerebral thromboembolism [1,2,3]. The mechanism of cerebral infarction after LUL lobectomy may include stasis of blood flow in the stump of the left upper pulmonary vein because the left upper pulmonary vein stump may be longer than other pulmonary vein remnants for anatomical reasons [2].…”

Section: Introductionmentioning

confidence: 99%

Acute cerebral infarction in a patient with an epidural catheter after left upper lobe resection: A case report

Kitajima

Otsuka

Sanui

et al. 2019

Preprint

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Background There are several recent reports that left upper lobe lung resection is a risk factor for the development of postoperative thromboembolism. Although administering epidural analgesia is common in thoracic surgery, anesthesiologists should be alert when administering epidural analgesia to a patient undergoing left upper lobectomy, considering the increased risk of postoperative thromboembolism and the potential need for anticoagulation or fibrinolytic therapy in the immediate postoperative period. Case presentation A seventy-one-year-old female with a metastatic lung lesion developed a cerebral infarction approximately 30 hours after video-assisted thoracoscopic left upper lobectomy. Cerebral intravascular therapy was indicated and the epidural catheter was removed immediately to avoid formation of an epidural hematoma. Approximately four hours after onset, reperfusion was successfully established by aspiration of endovascular thrombi. She recovered with mild residual paralysis of the left upper extremity and was transferred to a rehabilitation facility. Conclusions We present a patient with a cerebral infarction after left upper lobectomy. Left upper lobectomy is associated with an increased risk of postoperative thromboembolism. Although the exact mechanism of thrombosis after left upper lobectomy is unclear, a judicious decision should be made regarding epidural catheter placement for postoperative analgesia.

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Is left upper lobectomy for lung cancer a risk factor for cerebral infarction?

Abstract: Cerebral infarction occurs at a high frequency in patients who undergo left upper lobectomy for lung cancer. Thrombosis in the left superior pulmonary-vein stump might cause cerebral infarction.

Cited by 72 publications

References 20 publications

Cerebral Infarction After Lobectomy for Lung Cancer

Cerebral Infarction After Lobectomy for Lung Cancer

Pulmonary vein stump thrombosis after left pneumonectomy, diagnosed based on a high plasma D-dimer level: a case report

Acute cerebral infarction in a patient with an epidural catheter after left upper lobe resection: A case report

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