IMMEDIATE COMPLICATIONS

FOLLOWING PULMONARY ANATOMIC

RESECTIONS THE EXPERIENCE OF AN
ONCOLOGIC THORACIC SURGERY
DEPARTMENT

S.-T. Makkai-Popa, Luminia Ionescu, C. Sandu, M.

Bosnceanu
Second Surgical Clinic, Regional Institute for Oncology,
Iai

Introduction

Stitzenberg KB, Chang Y, Smith AB, Nielsen ME. Exploring

the burden of inpatient readmissions after major cancer
surgery. J Clin Oncol. 2015;33(5):455-64.

Introduction

PE Van Schil, JM Hendriks, P Lauwers. Focus on treatment complications and optimal management surgery. Transl
Lung Cancer Res. 2014;3(3):181-6.

Material and method

Retrospective study January 2013 August 2015 (32

months)
Patients undergoing anatomic lung resections
172 resections analysed
31 (18,02%) pneumonectomies
5 (2,91%) bilobectomies
136 (79,06%) lobectomies

Results
36 (20,93%) patients with complications
3 (1,74%) postoperative deaths due to complications
General complications:
3 (1,74%) postoperative arrythmias
1 (0,58%) postoperative stroke
Pleuro-pulmonary complications:
7 (4,06%) bronchial stump fistulas
8 (4,65%) pneumonias on the remaining parenchyma
1 (0,58%) empyema without fistula
1 (0,58%) chylothorax
11 (6,38%) persistent air leaks requiring hospital stays longer than

14 days
3 (1,74%) haemothorax requiring an iterative surgical procedure

Results
31 male patients and 5 female patients

Initial cohort
Age (years)
62,52 9,29
Length of hospital
stay (days)
14,54 8,16
Duration of the
surgical (min)
154,1 43,94

Complications
group
62,7 9,46
20,27 13,39
163,46 42,95

Results
Number of cases
17
9
2
1
1
1
1
1

Histologic type
adenocarcinoma
squamous cell carcinoma
small cell carcinoma
neuroendocrine carcinoma
pleomorphic sarcomatoid
carcinoma
adenomatoid cystic
malformation
bronchogenic cyst
aspergilloma

Results

Number of cases

Surgical procedure

28
7
1

lobectomy
pneumonectomy
bilobectomy

Discussion
30 days postoperative mortality:
6-20% after pneumonectomies1
3-8 % after lebectomies1
our experience - 1,74%
Postoperative morbidity up to 60%1
our experience 20,93%
neoadjuvant therapy?

Morbidity and mortality prediction scores2

1.
2.

S. Renaud, C. Renaud, A. Seguin, L. Brouchet, J. Berjaud, M. Dahan, P.-E. Falcoz. Principes de la chirurgie
d'exrse pulmonaire. Techniques chirurgicales thorax. Mise a jour 2013, vol. 8, no. 2, [42-230]
Brunelli A., Morgan-Hughes N.J., Refai M., Salati M., Sabbatini A., Rocco G. Risk-adjusted morbidity and mortality
models to compare the performance of two units after major lung resections. J Thorac Cardiovasc Surg.
2007;133(1):88-96.

Discussion
Bleeding complications:
0,1 3% following thoracotomies
less than 2% following thoracoscopies
our experience 1,74% - haemothorax iterative surgery
Cardiac complications:
arrhythmias 35%
myocardial infarction - 3,8%
cardiac herniation immediately after surgery - 50% mortality
our experience 1,74% arrhythmias, no myocardial infarction

Phrenic and recurrential lessions 1% - none in our experience

In our experience 1 stroke
S. Renaud, C. Renaud, A. Seguin, L. Brouchet, J. Berjaud, M. Dahan, P.-E. Falcoz. Principes de la chirurgie d'exrse
pulmonaire. Techniques chirurgicales thorax. Mise a jour 2013, vol. 8, no. 2, [42-230]

Discussion
Postpneumonectomy pulmonary edema 2-5%
Prolonged air leak, severe subcutaneous emphysema 50% - if

severe Michelin syndrome

our experience - 11 (6,38%) persistent air leaks requiring hospital stays

longer than 14 days

intra-operative control of bronchial stump
early extubation intra-alveolar pressure

Lobar torsion less than 0,5%

none in our experience regular preventive fixation of the remaining lobes
reintervention indicated emboli spread after untwisting intrapericardic
clamping of pulmonary veins recommended

PE Van Schil, JM Hendriks, P Lauwers. Focus on treatment complications and optimal management surgery. Transl
Lung Cancer Res. 2014;3(3):181-6.

Discussion
Empyema 2-12% in the literature
our experience 1 (0,58%) empyema without fistula on control
bronchoscopy
culture of pleural fluid before antibiotics
adequate chest tube drainage required
Bronchial stump fistulas incidence varies across

literature
our experience 7 (4,06%) bronchial stump fistulas
3 surgical revisions of the bronchial stump:
1 pneumonectomy
1 resection and closure of the bronchial stump
1 bronchial stump plasty with serratus muscle

4 bronchoscopically sealed bronchial stump fistulas

PE Van Schil, JM Hendriks, P Lauwers. Focus on treatment complications and optimal management surgery. Transl
Lung Cancer Res. 2014;3(3):181-6.

Discussion
Particular pleuro-pulmonary complications we encoutered:
1 (0,58%) chylothorax after the surgical treatment of a Stocker type
II adenomatoid cystic malformation in an adult (41 years old)

Discussion

Stitzenberg KB, Chang Y, Smith AB, Nielsen ME. Exploring the burden of inpatient readmissions after major
cancer surgery. J Clin Oncol. 2015;33(5):455-64.

Discussion

Stitzenberg KB, Chang Y, Smith AB, Nielsen ME. Exploring the burden of inpatient readmissions after major
cancer surgery. J Clin Oncol. 2015;33(5):455-64.

Discussion

Stitzenberg KB, Chang Y, Smith AB, Nielsen ME. Exploring the burden of inpatient readmissions after major
cancer surgery. J Clin Oncol. 2015;33(5):455-64.

Conclusion

Our experience so far is comparable to the data provided

in the current literature

Postoperative complications survival differences
Deficiencies in healing
Neoadjuvant therapy
Age