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Thrombus formation at the stump of the pulmonary vein after lobectomy: a prospective multi-institutional study

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Abstract

Purpose

Recent reports suggest that postoperative cerebral infarction following lung cancer surgery is caused by thrombus formation at the stump of the pulmonary vein and that the risk is highest after left upper lobectomy (LUL). Thrombosis at the stump of the pulmonary vein and the incidence of cerebral infarction was investigated prospectively in patients who underwent lobectomy for lung cancer.

Methods

Lung cancer patients undergoing planned pulmonary lobectomy were enrolled. The endpoint was to confirm if there is a higher incidence of thrombus formation (primary) and a higher incidence of cerebral infarction (secondary) in patients undergoing LUL. We planned to accrue 600 patients. An interim analysis was scheduled for just after the data center received the final clinical review form of the 300th patient.

Results

The interim analysis revealed a significant difference in the primary endpoint. In the final analysis, thrombus was identified in 16 of 88 LUL patients (20.5%), and in 4 of 247 patients who underwent other types of lobectomy (1.6%) (p < 0.05). Cerebral infarction was identified in 1 of the LUL patients (1.3%) and in 9 of the other patients (3.6%) (p = 0.318).

Conclusions

Thrombus frequently forms at the stump of the left superior pulmonary vein after LUL. However, our study did not identify a relationship between thrombosis and cerebral infarction.

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Data availability

The data produced and analyzed for this study are available from the corresponding author upon reasonable request.

Abbreviations

LUL:

Left upper lobectomy

VATS:

Video-assisted thoracoscopic surgery

CT:

Computed tomography

MRI:

Magnetic resonance imaging

BMI:

Body mass index

CBC:

Complete blood count

WBC:

White blood cell

RBC:

Red blood cell

HGB:

Hemoglobin

HCT:

Hematocrit

PLT:

Platelet

HbA1c:

Hemoglobin-A1c

LDL-Cho:

Low-density lipoprotein cholesterol

HGL-Cho:

High-density lipoprotein cholesterol

TG:

Triglyceride

BNP:

Brain natriuretic peptide

eGFR:

Estimated glomerular filtration rate

PT:

Prothrombin time

APTT:

Activated partial thromboplastin time

Fib:

Fibrinogen

FDP:

Fibrin degradation product

RUL:

Right upper lobectomy

RML:

Right middle lobectomy

RLL:

Right lower lobectomy

LLL:

Left lower lobectomy

VTE:

Venous thromboembolism

PVT:

Pulmonary vein thrombosis

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Acknowledgements

We gratefully acknowledge the work of past and present members of the Department of General Thoracic Surgery, Chiba University Graduate School of Medicine and Chiba Cancer Center.

Funding

None.

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Author notes

  1. Takayoshi Yamamoto and Hidemi Suzuki contributed equally to the work.

Authors and Affiliations

  1. Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan

    Takayoshi Yamamoto, Hidemi Suzuki, Yuichi Sakairi & Ichiro Yoshino

  2. Department of Thoracic Surgery, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba-shi, Chiba, 260-8717, Japan

    Takekazu Iwata & Toshihiko Iizasa

  3. Department of Surgery and Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Tetsuzo Tagawa

  4. Department of Thoracic Surgery, International University of Health and Welfare Atami Hospital, 13-1 Higasikaigancho, Atami, Shizuoka, 413-0012, Japan

    Shigetoshi Yoshida

  5. Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Ryo Takemura & Yasunori Sato

Authors
  1. Takayoshi Yamamoto
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  2. Hidemi Suzuki
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  3. Yuichi Sakairi
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  4. Takekazu Iwata
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  5. Toshihiko Iizasa
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  7. Shigetoshi Yoshida
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  8. Ryo Takemura
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  9. Yasunori Sato
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  10. Ichiro Yoshino
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Contributions

TY, HS, YS, YI, TI, TT and SY and IY were involved in the study design and data interpretation. TY, HS, RY, YS and IY were involved in the data analysis. All authors critically revised the report, commented on drafts of the manuscript, and approved the final report.

Corresponding author

Correspondence to Hidemi Suzuki.

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Yamamoto, T., Suzuki, H., Sakairi, Y. et al. Thrombus formation at the stump of the pulmonary vein after lobectomy: a prospective multi-institutional study. Surg Today 53, 1343–1351 (2023). https://doi.org/10.1007/s00595-023-02692-y

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  • DOI: https://doi.org/10.1007/s00595-023-02692-y

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