Abstract
Purpose
Postoperative bleeding is a potentially fatal complication after lung surgery and usually requires re-operation. The aim of this study was to analyze the characteristics of bleeding-related re-exploration following pulmonary resection and reduce the incidence of this complication.
Methods
From January 2016 to December 2020, 14,104 patients underwent pulmonary resection for lung cancer or pulmonary nodule at Fudan University Shanghai Cancer Center, China. We evaluated cases with bleeding-related re-exploration, and analyzed the relationship between postoperative bleeding and clinical characteristics. We further developed a protocol to reduce the proportion of bleeding-related re-exploration in our center.
Results
Bleeding-related re-exploration occurred in 85 (0.60%) out of 14,104 patients. The sources of postoperative bleeding included surgical incision (20, 23.53%), parietal pleura (20, 23.53%), bronchial artery (14, 16.47%), lung parenchyma (13, 15.29%), pulmonary vessel (5, 5.88%) and rare source of bleeding. There were various patterns of postoperative bleeding. Open thoracotomy had a significantly higher bleeding rate than video-assisted thoracoscopic surgery (VATS) (1.27% vs 0.34%, p < 0.0001). The bleeding rate of pneumonectomy, lobectomy, segmentectomy and wedge resection was significantly different (1.78%, 0.88%, 0.46% vs 0.28%, p < 0.0001). All patients were discharged successfully except for one patient died of respiratory failure. A protocol based on these findings was developed to reduce the proportion of bleeding-related re-exploration in our center.
Conclusion
Our findings revealed that the source of bleeding, surgical approach and procedure affected the pattern of postoperative bleeding. Postoperative bleeding could be managed properly on the timely decision of re-exploration considering its origin, severity, onset and risk factors.
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Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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Shanbo Zheng wrote the main manuscript text, Ting Ye and Bin Li collected and analyzed data, Yang Zhang and Hong Hu prepared figures 1 and 2, Haiquan Chen supervised the research. All authors reviewed the manuscript.
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Zheng, S., Ye, T., Li, B. et al. Bleeding-related re-exploration following pulmonary resection: a report of a single-center experience. J Cancer Res Clin Oncol 149, 6841–6848 (2023). https://doi.org/10.1007/s00432-023-04591-8
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DOI: https://doi.org/10.1007/s00432-023-04591-8