Multicentre prospective observational study for pulmonary vein stump thrombus after anatomical lung resections

• Published in: European journal of cardio-thoracic surgery Vol. 61; no. 1; pp. 92 - 99
• Main Authors: Hattori, Aritoshi, Takamochi, Kazuya, Shiono, Satoshi, Tsuboi, Masahiro, Maniwa, Yoshimasa, Suzuki, Kazuhiro, Suzuki, Kenji
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 27-12-2021
• Subjects: Humans; Lung; Lung Neoplasms - complications; Pneumonectomy - adverse effects; Pneumonectomy - methods; Prospective Studies; Pulmonary Veins - diagnostic imaging; Pulmonary Veins - surgery; Retrospective Studies; Thrombosis - etiology; Venous Thrombosis - complications; Venous Thrombosis - surgery; Pulmonary vein stump thrombus; Cerebral infarction; Multicentre study; Anatomical lung resection
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezab370

Abstract

OBJECTIVES
Our goal was to evaluate the incidence and frequent sites of pulmonary vein stump thrombus (PVST) formation after pulmonary resection.
METHODS
This is a prospective multicentre observational study conducted by 14 institutions in Japan. Enrolled patients underwent anatomical pulmonary resection including lobectomy, bilobectomy, pneumonectomy, left upper trisegmentectomy or lingular segmentectomy. Postoperative contrast-enhanced computed tomography was performed in the early period after the pulmonary resection to evaluate the incidence of PVST. Furthermore, univariable and multivariable analyses were performed to assess the risk factors associated with PVST using a logistic regression model.
RESULTS
The status of PVST based on postoperative contrast-enhanced computed tomography scans was prospectively evaluated for 1040 patients. Postoperative computed tomography evaluation was performed for 3 (range: 1–84) days on average after the pulmonary resection. PVST was found in 127 (12.2%) patients with left-sided (23.3%) predominance compared to the right side (4.9%) (P < 0.001). Furthermore, left upper lobectomy was the most frequent operative procedure (30.8%). Multivariable analyses demonstrated that left upper lobectomy (P = 0.001) and left-sided pulmonary resection (P < 0.001) were independent significant predictors of PVST. Cerebral infarction was observed in 9 (0.87%) patients during this period and included 6 (1.46%) in whom it developed after the operation was performed on the left side. Especially in the early postoperative phase, left pulmonary resection was significantly associated with the incidence of cerebral infarction (0.16% vs 1.21%; P = 0.028).
CONCLUSIONS
PVST is an early postoperative event that is frequently observed in patients undergoing left anatomical pulmonary resection, especially a left upper lobectomy.
IRB number
16-205, Clinical trial registry: UMIN000027118.
Based on the annual report from the Japanese Association of Thoracic Surgery, pulmonary lobectomy is by far the most frequent operative mode, with more than 30 000 cases per year among the general thoracic operative procedures; it accounts for ∼74% of all surgical cases [1].