Complications In Lung Cancer Surgery Research Articles

Development of a machine learning-based risk model for postoperative complications of lung cancer surgery.

To develop a comorbidity risk score specifically for lung resection surgeries. We reviewed the medical records of patients who underwent lung resections for lung cancer, and developed a risk model using data from 2014 to 2017 (training dataset), validated using data from 2018 to 2019 (validation dataset). Forty variables were analyzed, including 35 factors related to the patient's overall condition and five factors related to surgical techniques and tumor-related factors. The risk model for postoperative complications was developed using an elastic net regularized generalized linear model. The performance of the risk model was evaluated using receiver operating characteristic curves and compared with the Charlson Comorbidity Index (CCI). The rate of postoperative complications was 34.7% in the training dataset and 21.9% in the validation dataset. The final model consisted of 20 variables, including age, surgical-related factors, respiratory function tests, and comorbidities, such as chronic obstructive pulmonary disease, a history of ischemic heart disease, and 12 blood test results. The area under the curve (AUC) for the developed risk model was 0.734, whereas the AUC for the CCI was 0.521 in the validation dataset. The new machine learning model could predict postoperative complications with acceptable accuracy. 2020-0375.

The role of body mass index in postoperative complications of surgical treatment for early-stage lung cancer cases

Aim: Body mass index is an important condition that may affect postoperative complications. Although there are studies on this subject in the literature, we aimed to reveal the relationship between body mass index and complications in lung cancer surgery more distinctly by limiting the factors that may directly affect postoperative complications such as operation type and staging.Methods: Patients undergoing thoracotomy and lobectomy for early-stage primary lung cancer in our clinic between January 2014 and October 2021 were retrospectively analyzed. The demographic characteristics of the 292 patients and their body mass indexes (BMI) were grouped in line with the recommendation of the World Health Organization and analyzed in terms of postoperative complications and length of stay.Results: The mean age of the cases was 61.93±0.55 (34-86) years, and the mean body mass index was 26.89±0.30 (16.44-58.27) kg/m². The mean BMI value was 17.40 kg/m² for group 1, 22.55 kg/m² for group 2, 27.25 kg/m² for group 3, and 33.75 kg/m² for group 4. At least one complication developed in 71.4% of the cases in group 1, these values were 58.5% - 52.8% - 35.2% for group 2, group 3, and group 4, respectively. It was determined that cases with high body mass index had a lower risk of developing complications in the postoperative period (p=0.003).Conclusion: We found that body mass index is a factor that can give an idea about postoperative complications, prolonged air drainage, and hemorrhage in patients for whom resection is planned due to lung cancer.

Everybody knows that smokin’ ain’t allowed (in school) before lung surgery!

In the 1973 classic ‘Smokin’ in the Boys Room’, the Brownsville Station’s singer refrain is—‘don’t want the teacher to fill me up with your rules, but everybody knows that smokin’ ain’t allowed in school!’ [1] Similarly, the universal medical directive including pre-op lung cancer resection is ‘Stop Smoking’. Kadomatsu, Sugiyama and others in the article ‘Relationship of smoking cessation period with the incidence of complications in lung cancer surgery’ [2] re-evaluates the length of smoking cessation and pack-years of smoking on lung cancer resection morbidity and outcomes. The authors have shown in 911 patients undergoing lung cancer resection from 2014 to 2017 that pulmonary complications including pneumonia, prolonged air-leak and empyema and total complications are 5 times and 2 times higher respectively in smokers as compared to the non-smoker groups. The pre-op smoking cessation intervals included—9.6% patients in the current (<4 weeks) group, 17% patients in recent (4 weeks to 12 months) group, 13% in the distant (12 months to 5 years) group and 30% ex-smokers (>5 years) group. Using this classification, postoperative complications were greater in current versus recent groups but both were less than distant and ex-smoker cohorts. Interestingly, the ex-smoker group had fewer post-op complications than the distant group and the distant cohort had more complications than the current and recent smoking groups.

Relationship of smoking cessation period with the incidence of complications in lung cancer surgery

The incidence of postoperative complications is relatively high in smokers. Although 4-week smoking cessation before surgery is generally recommended, it has not been sufficiently studied in lung cancer surgery. This study investigated whether smoking cessation for a short period of time significantly reduced complications after lung cancer surgery. This was a retrospective, observational study that investigated the relationship between the smoking cessation period and the incidence of complications in lung cancer surgery. Patients who underwent curative-intent surgery for lung cancer at our institution between January 2014 and December 2017 were included. The smokers were classified into the following 4 categories of smoking cessation period before surgery: current (<4 weeks), recent (4 weeks to 12 months), distant (12 months to 5 years) and ex-smokers (>5 years). A total of 911 patients were included in this study. The incidence of pulmonary complications was 5 times higher in the smoker group than in the never smoker group (12.9% vs 2.5%, P < 0.001). On multivariable analysis in both models, the odds ratio for complications was significantly higher in distant smokers than in recent smokers and never smokers. Across all models, low lung function significantly predicted the development of postoperative complications. The evidence-based smoking cessation duration that reduces the incidence of complications after thoracic surgery remains unclear. The incidence of postoperative complications was more strongly affected by low pulmonary function than by the duration of preoperative smoking cessation. For patients with marginal indications for surgery, postponing surgery to accommodate a smoking cessation period seemed unnecessary.

The left main bronchus transected incorrectly during video-assisted thoracoscopic lobectomy: a case report

BackgroundSeveral severe intraoperative complications of lung cancer surgery have been reported, but the incorrect transection of the main bronchus is a very rare and serious complication. We report a surgical case of a patient with left lower lobe lung cancer invading the inferior segment of the lingula, with fused interlobar fissure and dense pleural adhesion, in which the left main bronchus was mistaken for the left lower lobe bronchus and was transected.Case presentationA 64-year-old woman with lung adenocarcinoma was referred to our hospital for surgical treatment. Chest computed tomography (CT) scan showed a 30-mm nodule with a clear border and irregular margins in the center of the anterior (S8) segment of the lower lobe of the left lung and another similar 30-mm nodule in the lateral (S9) segment of the same lobe. Metastasis within the same lobe was suspected. A thoracoscopic left lower lobectomy was scheduled for the patient. As the patient had a moderately, fused fissure, dense pleural adhesion, and suspicious tumor invasion from the left S8 segment to the left S5 segment, and the interlobar node tightly adhered to the main PA at the site of basilar artery origin of the LLL, we performed left lower lobectomy and a left S5 segmentectomy using the fissureless fissure-last technique. During surgery, the left main bronchus was mistaken for the left lower lobe bronchus and was transected. After transecting the left main bronchus, we performed a sleeve bronchoplasty to prevent pneumonectomy.ConclusionsWe experienced the rare and serious intraoperative complication of the incorrect transection of the main bronchus. There are few reports of this intraoperative complication, and it should not be overlooked by surgeons.

Anatomical consideration of the cardiac plexus to prevent grave bradycardiac arrhythmias associated with lung cancer surgery: a case report

BackgroundArrhythmias are known as one of the complications of lung cancer surgery, and most of them are not lethal. Life-threatening arrhythmias have been reported in the literature but in reality very rare.Case presentationA 67-year-old Japanese man with a history of hypertension was diagnosed with squamous cell carcinoma in left lower lobe underwent a left lower lobectomy and bilateral mediastinal lymph node dissection through a median sternotomy. During lymph node dissection along the right vagus nerve, the patient’s heart rate and blood pressure dropped suddenly and an electrocardiogram monitor showed ST elevation. These abnormalities returned to normal soon after cardiac massage was performed and a coronary vasodilator was given. A temporary pacing wire was inserted at the end of the surgery. The postoperative course was uneventful and the patient was discharged on postoperative day 11 without a need for permanent pacemaker.ConclusionsWe present a patient who was complicated with lethal arrhythmias during lung cancer surgery for the purpose of elucidating, from anatomical viewpoint, the relationship between arrhythmias and the involvement of cardiac plexus during lymph node dissection. The result showed that arrhythmia was inadvertently elicited by cardiac plexus stimulation during lymph nodes dissection around the vagus nerve. It is important to be familiar not only with the course of phrenic, vagus, and recurrent laryngeal nerve but also the anatomy of cardiac plexus to prevent arrhythmic complications in lung cancer surgery.

Attempt of peripheral nerve reconstruction during lung cancer surgery.

BackgroundVagus nerve and recurrent laryngeal nerve (RLN) injury are not rare complications of lung cancer surgery and can cause lethal consequences. Until now, no optimal method other than paying greater attention during surgery has been available.MethodsFour patients underwent lung surgery that involved RLN or vagus nerve injury. The left RLN or vagus nerve was cut off and then reconstructed immediately during surgery. Two patients underwent direct anastomosis, while the remaining two underwent phrenic nerve replacing tension‐relieving anastomosis.ResultsAll patients were able to speak immediately after recovery. No or minimal glottal gap was observed during laryngoscopy conducted on the second day after surgery. Most patients achieved full recovery of voice quality.ConclusionsImmediate reconstruction of RLN is technically feasible and can be carried out with satisfying short‐term and long‐term outcomes.

Prediction of postoperative pulmonary complications in lung cancer surgery: Is proportion of emphysema important?

OBJECTIVE: Preoperative evaluation in thoracic surgery is highly important to determine surgical suitability, estimate postoperative pulmonary complications, and for patient follow-up. However, there is neither a definite explanation about the possible complications nor a gold standard method. MATERIALS AND METHODS: In this study, 297 patients undergoing anatomic lung resection for primary lung carcinoma were retrospectively evaluated. To form a homogeneous group, all factors that increase the rate of pulmonary complication were excluded except emphysema. Patients who did not meet these criteria were removed from the study. The study continued with 104 other patients. This patient subgroup was divided into groups according to Goddard Classification– Score (GdCS). The correlation between GdCS and other variables was statistically investigated. RESULTS: According to the GdCS of 104 patients, the patient distribution was as follows: 10 patients (9.6%) were G0, 28 patients (26.9%) were G1, 42 patients (40.4%) were G2, 22 patients (21.2%) were G3, and 2 patients (1.9%) were G4. Thirty-five (33.6%) of 104 patients had a pulmonary complication during the postoperative follow-up. The average drainage time was longer for higher GdCS scores, and the rate of exposition to a pulmonary complication was higher in the patients with increased GdCS. CONCLUSION: In view of these findings, Goddard's scoring for chronic obstructive pulmonary disease-emphysema patients was considered likely to be an indicative parameter in the preoperative evaluation and postoperative follow-up of thoracic surgery patients.

Three-dimensional computed tomography angiography of the pulmonary veins and their anatomical variations: involvement in video-assisted thoracoscopic surgery-lobectomy for lung cancer.

Identification and section of pulmonary veins are an essential part of anatomical pulmonary resections. Intraoperative misunderstandings of pulmonary venous anatomy can lead to serious complications such as bleeding and delayed lung infarction or necrosis. We evaluated principally the rate of pulmonary veno-us anatomical variations, and secondarily the reliability and clinical outcomes of a preoperative morphological analysis. Between November 2012 and October 2013, we studied 100 consecutive patients with highly suspected or diagnosed stage I-II primitive lung cancer lesion. The surgical procedure initially retained was video-assisted thoracoscopic surgery (VATS) pulmonary resections and we studied preoperatively the proximal pulmonary venous anatomy using 64 channels multi- -detector computed tomography (CT)-scan angiography to describe the venous anatomical variations. There were 65 men and 35 women with a mean age of 63 years. A pulmonary venous anatomical variation was present in 36 (36%) patients, and right-sided anatomical variations were more frequent than on left-sided ones (25% vs. 11%). The most frequent variation encountered on the right side was the existence of three separate pulmonary veins (16%), and on the left side a single pulmonary vein (8%). Surgical conversion occurred in 21% and we didn't experience a pulmonary venous lesion (0%) or a post-operative lung infarction (0%). We described pulmonary venous anatomical variations and their frequency. Anatomical variations exist and preoperative assessment of pulmo-nary venous anatomy using CT scan is a useful tool in VATS lobectomy to avoid unnecessary extension of pulmonary resections or iatrogenic complications in lung cancer surgery.

The world's first clinical randomized trial of atrial natriuretic peptide for preventing cancer recurrence following lung cancer surgery

Most patients suffering from cancer die of metastatic disease. Surgical removal of solid tumors is performed as an initial attempt to cure patients if the primary tumor meets surgical indications. However, it is possible that surgical trauma itself influences the development of early recurrence. First, resection handling of the tumor can provoke detachment of tumor cells. Second, surgical trauma provokes the severe inflammatory reaction. Vascular inflammation is considered to render the endothelium adhesive to circulating tumor cells thereby allowing the metastasis of tumor cells. We have previously reported that administration of atrial natriuretic peptide (ANP) during the perioperative period reduces inflammatory response and has a prophylactic effect on postoperative cardiopulmonary complications in lung cancer surgery. Here we demonstrate that cancer recurrence after curative surgery was significantly lower in ANP-treated patients than in control patients (surgery alone). ANP is known to bind specifically to guanylyl cyclase-A (GC-A) receptor. In mouse models, we found that metastasis of GC-A–non-expressing tumor cells (i.e., B16 mouse melanoma cells) to the lung was increased in vascular endothelium-specificGC-A knockout mice and decreased in vascular endothelium-specific GC-A transgenic mice compared with control mice. ANP inhibited the adhesion of cancer cells to human pulmonary artery endothelial cells by suppressing the E-selectin expression that is promoted by inflammation. These results suggest that ANP prevents cancer metastasis by inhibiting the adhesion of tumor cells to inflamed endothelial cells. Thus, we have planned to start a multicenter randomized clinical trial to examine the use of perioperative administration of ANP for the prevention of cancer recurrence after lung cancer surgery in this year. In the near future, we want to expand the adaptation of ANP for various types of cancer surgery.

RETRACTED: Atrial natriuretic peptide prevents cancer metastasis through vascular endothelial cells

Most patients suffering from cancer die of metastatic disease. Surgical removal of solid tumors is performed as an initial attempt to cure patients; however, surgery is often accompanied with trauma, which can promote early recurrence by provoking detachment of tumor cells into the blood stream or inducing systemic inflammation or both. We have previously reported that administration of atrial natriuretic peptide (ANP) during the perioperative period reduces inflammatory response and has a prophylactic effect on postoperative cardiopulmonary complications in lung cancer surgery. Here we demonstrate that cancer recurrence after curative surgery was significantly lower in ANP-treated patients than in control patients (surgery alone). ANP is known to bind specifically to NPR1 [also called guanylyl cyclase-A (GC-A) receptor]. In mouse models, we found that metastasis of GC-A-nonexpressing tumor cells (i.e., B16 mouse melanoma cells) to the lung was increased in vascular endothelium-specific GC-A knockout mice and decreased in vascular endothelium-specific GC-A transgenic mice compared with control mice. We examined the effect of ANP on tumor metastasis in mice treated with lipopolysaccharide, which mimics systemic inflammation induced by surgical stress. ANP inhibited the adhesion of cancer cells to pulmonary arterial and micro-vascular endothelial cells by suppressing the E-selectin expression that is promoted by inflammation. These results suggest that ANP prevents cancer metastasis by inhibiting the adhesion of tumor cells to inflamed endothelial cells.

Impact of cardiopulmonary complications of lung cancer surgery on long-term outcomes.

The impact of postoperative cardiopulmonary complications on long-term outcomes has not been established. We investigated the effects of acute postoperative cardiopulmonary complications not only on cancer recurrence, but also on cardiovascular or respiratory events in the chronic phase after lung cancer surgery. From a prospective single-institution database of 496 consecutive patients, who underwent lung cancer surgery between August, 2008 and December, 2011, medical records, including information about cardiovascular or respiratory events and cancer recurrence in the chronic phase (>6 months) after surgery, were analyzed retrospectively. Results were compared between patients with vs. those without postoperative cardiopulmonary complications in the acute phase. Postoperative cardiopulmonary complications were identified in 90 (20%) patients. There were significantly more cardiovascular or respiratory events in the chronic phase after lung cancer surgery in the patients who had suffered postoperative cardiopulmonary complications in the acute phase than in those who had not (23 vs. 5%; p < 0.0001). Postoperative cardiopulmonary complications in the acute phase were associated with a higher incidence of cardiovascular or respiratory events in the chronic phase after lung cancer surgery. JPRN-UMIN2370.