Abstract

Pneumonectomy is associated with high mortality and high rates of complications. Postpneumonectomy pulmonary edema is one of the leading causes of mortality. Little is known about its etiologic factors and its association with the inflammatory process. The purpose of the present study was to evaluate the role of pneumonectomy as a cause of pulmonary edema and its association with gas exchange, inflammation, nitric oxide synthase (NOS) expression and vasoconstriction. Forty-two non-specific pathogen-free Wistar rats were included in the study. Eleven animals died during or after the procedure, 21 were submitted to left pneumonectomy and 10 to sham operation. These animals were sacrificed after 48 or 72 h. Perivascular pulmonary edema was more intense in pneumonectomized rats at 72 h (P = 0.0131). Neutrophil density was lower after pneumonectomy in both groups (P = 0.0168). There was higher immunohistochemical expression of eNOS in the pneumonectomy group (P = 0.0208), but no statistically significant difference in the expression of iNOS. The lumen-wall ratio and pO(2)/FiO(2) ratio did not differ between the operated and sham groups after pneumonectomy. Left pneumonectomy caused perivascular pulmonary edema with no elevation of immunohistochemical expression of iNOS or neutrophil density, suggesting the absence of correlation with the inflammatory process or oxidative stress. The increased expression of eNOS may suggest an intrinsic production of NO without signs of vascular reactivity.

Highlights

  • Pulmonary lobectomy is the standard surgical procedure for lung cancer, pneumonectomy is still required in some cases

  • Pneumonectomy did not lead to a significant initial increase (48 h) of perivascular edema when compared to the respective control groups

  • The physiological alterations that occur after pneumonectomy in a previously normal individual have not been fully explained

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Summary

Introduction

Pulmonary lobectomy is the standard surgical procedure for lung cancer, pneumonectomy is still required in some cases. Central or bulky tumors are examples of complete resection requiring pneumonectomy. Several other inflammatory lung diseases, tuberculosis, bronchiectasis, and other non-malignant conditions may require this intervention. In comparison with other surgical procedures, mortality for pneumonectomy is relatively high, ranging from 0 to 9.4% [1,2]. Mortality can be even higher when associated with preoperative chemotherapy [3]. The combination with other procedures such as extrapleural pneumonectomy is associated with a mortality rate of 4 to 7% [4,5]. Traumatic injuries requiring emergency pneumonectomy can achieve mortality rates higher than 70% [6]. When compared to pulmonary lobectomy, the mortality rate can increase almost ten-fold [7]

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