Risk Factors for Postoperative Cerebral Infarction in Lung Cancer Patients: a Retrospective Study

Overview

Journal J Cardiothorac Surg

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2023 Apr 11

PMID 37041555

Authors

Natsumi Maru

Haruaki Hino

Takahiro Utsumi

Hiroshi Matsui

Yohei Taniguchi

Tomohito Saito

Tomohiro Murakawa

Affiliations

Soon will be listed here.

Abstract

Background: Postoperative cerebral infarction is a rare but serious complication after lung cancer surgery. We aimed to investigate the risk factors and evaluate the efficiency of our devised surgical procedure to prevent cerebral infarction.

Methods: We retrospectively examined 1,189 patients who underwent a single lobectomy for lung cancer at our institution. We identified the risk factors for cerebral infarction and investigated the preventive effects of performing resection of the pulmonary vein as the last step of the surgical procedure during left upper lobectomy.

Results: Among the 1,189 patients, we identified 5 male patients (0.4%) with postoperative cerebral infarction. All five underwent left-sided lobectomy including three upper and two lower lobectomies. Left-sided lobectomy, a lower forced expiratory volume in 1 s, and lower body mass index were associated with postoperative cerebral infarction (Ps < 0.05). The 274 patients who underwent left upper lobectomy were stratified by two procedures: lobectomy with resection of the pulmonary vein as the last step of the surgical procedure (n = 120) and the standard procedure (n = 154). The former procedure significantly shortened the length of the pulmonary vein stump when compared with the standard procedure (mean stump length: 15.1 vs. 18.6 mm, P < 0.01), and the shorter pulmonary vein might possibly prevent postoperative cerebral infarction (frequency: 0.8% vs. 1.3%, Odds ratio: 0.19, P = 0.31).

Conclusions: Resecting the pulmonary vein as the last step during the left upper lobectomy enabled the length of the pulmonary stump to be significantly shorter, which may contribute to preventing cerebral infarction.

Citing Articles

Internal carotid bulb occlusion by a giant thrombus after thoracoscopic left upper lung lobectomy successfully treated with endovascular stenting: a case report.

Saito T, Kunieda T, Hashimoto Y, Ishida M, Maru N, Utsumi T Gen Thorac Cardiovasc Surg Cases. 2024; 2(1):104.

PMID: 39516990 PMC: 11533466. DOI: 10.1186/s44215-023-00116-4.

Pulmonary vein stump thrombosis and organ infarction after lung lobectomy.

Sawa T, Saeyup P, Kinoshita M, Kainuma A, Ogawa S, Amaya F J Anesth. 2024; 38(6):866-878.

PMID: 39126427 DOI: 10.1007/s00540-024-03389-3.

References

Sin D, Paul Man S . Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation. 2003; 107(11):1514-9. DOI: 10.1161/01.cir.0000056767.69054.b3. View

Ohtaka K, Hida Y, Kaga K, Iimura Y, Shiina N, Muto J . Pulmonary vein thrombosis after video-assisted thoracoscopic left upper lobectomy. J Thorac Cardiovasc Surg. 2011; 143(1):e3-5. DOI: 10.1016/j.jtcvs.2011.09.025. View

Wei S, Guo C, He J, Tan Q, Mei J, Yang Z . Effect of Vein-First vs Artery-First Surgical Technique on Circulating Tumor Cells and Survival in Patients With Non-Small Cell Lung Cancer: A Randomized Clinical Trial and Registry-Based Propensity Score Matching Analysis. JAMA Surg. 2019; 154(7):e190972. PMC: 6495366. DOI: 10.1001/jamasurg.2019.0972. View

Mizukami Y, Tada M, Adachi H . Cerebral infarction after left upper lung lobectomy with central vascular ligation. J Thorac Dis. 2020; 12(5):2210-2219. PMC: 7330416. DOI: 10.21037/jtd.2020.04.02. View

Kimura D, Fukuda I, Tsushima T, Sakai T, Umetsu S, Ogasawara Y . Management of acute ischemic stroke after pulmonary resection: incidence and efficacy of endovascular thrombus aspiration. Gen Thorac Cardiovasc Surg. 2018; 67(3):306-311. DOI: 10.1007/s11748-018-1024-9. View

Umehara T, Takumi K, Ueda K, Tokunaga T, Harada-Takeda A, Suzuki S . Four-dimensional flow magnetic resonance imaging study to explain high prevalence of pulmonary vein stump thrombus after left upper lobectomy. J Thorac Dis. 2020; 12(10):5542-5551. PMC: 7656367. DOI: 10.21037/jtd-20-1606. View

Hattori A, Takamochi K, Kitamura Y, Matsunaga T, Suzuki K, Oh S . Risk factor analysis of cerebral infarction and clinicopathological characteristics of left upper pulmonary vein stump thrombus after lobectomy. Gen Thorac Cardiovasc Surg. 2018; 67(2):247-253. DOI: 10.1007/s11748-018-1017-8. View

Chaaya G, Vishnubhotla P . Pulmonary Vein Thrombosis: A Recent Systematic Review. Cureus. 2017; 9(1):e993. PMC: 5323025. DOI: 10.7759/cureus.993. View

Matsumoto M, Takegahara K, Inoue T, Nakaza M, Sekine T, Usuda J . 4D Flow MR Imaging Reveals a Decrease of Left Atrial Blood Flow in a Patient with Cardioembolic Cerebral Infarction after Pulmonary Left Upper Lobectomy. Magn Reson Med Sci. 2020; 19(4):290-293. PMC: 7809149. DOI: 10.2463/mrms.ici.2019-0142. View

10.

Pillai J, Barnard S . Cardiac tamponade: a rare complication after pulmonary lobectomy. Interact Cardiovasc Thorac Surg. 2007; 2(4):657-9. DOI: 10.1016/S1569-9293(03)00188-9. View

11.

Duan X, Zhu Y, Cui Y, Yang Z, Zhou S, Han Y . Circulating tumor cells in the pulmonary vein increase significantly after lobectomy: A prospective observational study. Thorac Cancer. 2018; 10(2):163-169. PMC: 6360218. DOI: 10.1111/1759-7714.12925. View

12.

Hattori A, Takamochi K, Shiono S, Tsuboi M, Maniwa Y, Suzuki K . Multicentre prospective observational study for pulmonary vein stump thrombus after anatomical lung resections. Eur J Cardiothorac Surg. 2021; 61(1):92-99. DOI: 10.1093/ejcts/ezab370. View

13.

Lababede O, Meziane M . The Eighth Edition of TNM Staging of Lung Cancer: Reference Chart and Diagrams. Oncologist. 2018; 23(7):844-848. PMC: 6058324. DOI: 10.1634/theoncologist.2017-0659. View

14.

Yamamoto T, Suzuki H, Nagato K, Nakajima T, Iwata T, Yoshida S . Is left upper lobectomy for lung cancer a risk factor for cerebral infarction?. Surg Today. 2015; 46(7):780-4. DOI: 10.1007/s00595-015-1233-0. View

15.

Refaely Y, Sadetzki S, Chetrit A, Simansky D, Paley M, Modan B . The sequence of vessel interruption during lobectomy for non-small cell lung cancer: is it indeed important?. J Thorac Cardiovasc Surg. 2003; 125(6):1313-20. DOI: 10.1016/s0022-5223(03)00022-9. View

16.

Hashimoto H, Usui G, Tsugeno Y, Sugita K, Amori G, Morikawa T . Cerebral Thromboembolism after Lobectomy for Lung Cancer: Pathological Diagnosis and Mechanism of Thrombus Formation. Cancers (Basel). 2019; 11(4). PMC: 6521235. DOI: 10.3390/cancers11040488. View

17.

Matsumoto K, Sato S, Okumura M, Niwa H, Hida Y, Kaga K . Left upper lobectomy is a risk factor for cerebral infarction after pulmonary resection: a multicentre, retrospective, case-control study in Japan. Surg Today. 2020; 50(11):1383-1392. DOI: 10.1007/s00595-020-02032-4. View

18.

Ohtaka K, Hida Y, Kaga K, Kato T, Muto J, Nakada-Kubota R . Thrombosis in the pulmonary vein stump after left upper lobectomy as a possible cause of cerebral infarction. Ann Thorac Surg. 2013; 95(6):1924-8. DOI: 10.1016/j.athoracsur.2013.03.005. View

19.

Xie N, Meng X, Wu C, Lian Y, Wang C, Yu M . Both left upper lobectomy and left pneumonectomy are risk factors for postoperative stroke. Sci Rep. 2019; 9(1):10432. PMC: 6639360. DOI: 10.1038/s41598-019-46989-w. View

20.

Miyoshi R, Nishikawa S, Tamari S, Noguchi M, Hijiya K, Chihara K . Pulmonary vein thrombosis after lobectomy with vein stump closure by ligation. Asian Cardiovasc Thorac Ann. 2018; 26(7):546-551. DOI: 10.1177/0218492318802141. View