Radical Lymphadenectomy Does Not Effect Intrathoracic Fluid Volume Changes After Lung Surgery

Abstract

Objectives: The extent of lung tissue removal in thoracic surgery is known to have a large influence on postoperative edema. The relationship of radical lymphadenectomy and postop edema is controversial and investigated in this study. Design: 32 patients undergoing lung resection (16 lobectomies, 3 sleeve lobectomies, 10 pneumonectomies, 3 carinaresections) for cancer were randomized by type of lymphadenectomy (sampling or radical). Using trans-cardio-pulmonary thermodilution method (PiCCOTM) intra thoracic blood volume index (ITBI), extra lung water volume index (ELWI), and cardiac index (CI), were determined preand postoperatively at 0, 12, 24, 36 and 48 hours. The influence of postoperative lung volume reduction was then mathematically corrected (ELWI-corr). Results: ELWI-corr was significantly higher in bronchus sleeve resections within 12 hours in lobecomies (p=0.003) and pneumonectomies (p=0.031), whereas the ITBI remains stable in lobectomies, but decreased significantly within 48 hours in pneumonetomies (p=0.002) although clinical lung edema was not observed. No significant differences were found between sampling and radical lymphadenectomy (p>0,3). No significant changes were observed for CI and CVP between procedural or lymphadenectomy groups. Conclusions: There were no differences in ELWI, CI and ITBI between lymph node sampling and radical lymphadenectomy. Bronchus sleeve procedures alone showed a drastic increase in ELWI. For each patient, ELWI needs to be normalized to the preoperative value and the postoperative lung volume (ELWI-corr). Anticipating significant lung edema, especially in sleeve resection patients, by monitoring ELWI-corr should improve the clinical outcome. This work was orally presented at the 3 rd EACTS/ESTS Joint Meeting September 2004, Leipzig, Germany