Postoperative complications after thoracic surgery for lung cancer

Rotman, J; Plodkowski, Andrew J.; Hayes, Sara A.; Groot, Patricia M. de; Shepard, Jo Anne O.; Munden, Reginald F.; Ginsberg, Michelle S.

doi:10.1016/j.clinimag.2015.05.013

Cited by 42 publications

(30 citation statements)

References 76 publications

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“…[5][6][7][8][9][10] Because of the limited resection range and ease of use, the incidence of postoperative complications after thoracoscopic wedge resection is low. 6,8,9,[11][12][13] The tubeless strategy, which directly omits chest tube drainage, was first used in a thoracoscopic wedge resected population. [13][14][15][16][17] However, previous studies have reported that this procedure has an increased rate of complications, especially pneumothorax (5.9-40%).…”

Section: Introductionmentioning

confidence: 99%

Prophylactic air‐extraction strategy after thoracoscopic wedge resection

et al. 2018

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BackgroundSince 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.MethodsBetween 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.ResultsOptimal 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.ConclusionsThe 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.

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Section: Introductionmentioning

confidence: 99%

Prophylactic air‐extraction strategy after thoracoscopic wedge resection

et al. 2018

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“…CT can distinguish between simple and hemorrhagic fluid, which appears heterogeneously high attenuation on Pulmonary edema typically occurs after 2-3 days, and is more frequent post EPP, especially on the right (Figure 1) (16). This is thought to be caused by increased pulmonary blood flow to the left lung which overwhelms the lymphatics that usually receive approximately 45% of pulmonary blood flow (46). The edema tends to involve the lower lobe initially due to differential differences in blood flow between the upper and lower lobes, often mistaken as pneumonia or aspiration.…”

Section: Pulmonarymentioning

confidence: 99%

“…Common causes of infection include aspiration of gastric contents, bacterial colonization of atelectatic lung and presence of a bronchopleural fistula (BPF). The most common radiographic appearance is multifocal patchy consolidation in a bronchocentric distribution, representing a bronchopneumonia, lobar consolidation is less frequent (43,46). CT demonstrates consolidation and ground glass opacification (GGO), with mucus plugging and bronchial wall thickening suggestive of aspiration as an etiology.…”

Section: Pulmonarymentioning

confidence: 99%

“…Acute BPF usually occur within the first two weeks, and is more common after EPP than EP/D (2.3% vs. 0.4% respectively, Table 1) (17,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). BPFs are more common following right EPP, probably due to the wider bronchial stump and single bronchial arterial supply (43,46). Risk factors include prolonged mechanical ventilation, preoperative radiation treatment, fever, infection and excessive mucus pooling in the bronchial stump (16).…”

Section: Pulmonarymentioning

confidence: 99%

“…EPF usually present with an empyema with the presence of ingested air and food particles in the empyema cavity. Fluoroscopy or CT with water soluble oral contrast may directly demonstrate the fistula; placing the patient's pneumonectomy side down during oral contrast administration can aid delineation of the fistulous tract (46,57). Surgical treatment is usually required to repair the esophageal wall to prevent continued infection of the pneumonectomy space.…”

Section: Esophagopleural Fistula (Epf)mentioning

confidence: 99%

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Overview of treatment related complications in malignant pleural mesothelioma

Murphy

Gill

2017

Ann. Transl. Med.

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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.

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

et al. 2023

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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.

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Postoperative complications after thoracic surgery for lung cancer

Cited by 42 publications

References 76 publications

Prophylactic air‐extraction strategy after thoracoscopic wedge resection

Prophylactic air‐extraction strategy after thoracoscopic wedge resection

Overview of treatment related complications in malignant pleural mesothelioma

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

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