Video yardımlı torakoskopik cerrahi yapılan hastalarda intraoperatif kan kaybının ameliyat sonrası akciğer komplikasyonları üzerine etkisi

Amaç: Bu çalışmada küçük hücreli dışı akciğer kanseri için video yardımlı torakoskopik lobektomi uygulanan hastalarda intraoperatif kan kaybının ameliyat sonrası akciğer komplikasyonları üzerindeki etkisi araştırıldı. Çalışma planı: Temmuz 2017 - Nisan 2018 tarihleri arasında Evre I-IIIa küçük hücreli dışı akciğer kanseri için akciğer rezeksiyonu yapılan toplam 409 hastanın (227 erkek, 182 kadın; medyan yaş: 62 yıl; dağılım, 20-86 yıl) verileri retrospektif olarak incelendi. Ameliyat sonrası akciğer komplikasyonlarının öngörülmesinde intraoperatif kan kaybının eşik değerini doğrulamak için alıcı işletim karakteristik analizi yapıldı. Yüksek intraoperatif kan kaybı ve düşük intraoperatif kan kaybı gruplarını karşılaştırmak için eğilim skoru eşleştirmesi yapıldı. Ameliyat sonrası akciğer komplikasyonlarının bağımsız risk faktörlerini belirlemek için eşleştirme sonrası koşullu lojistik regresyon yapıldı. Bulgular: Hastaların 86’sında (%21.03) ameliyat sonrası akciğer komplikasyonları gelişti. Eğilim skoru eşleştirme analizinde, intraoperatif kan kaybının ameliyat sonrası akciğer komplikasyonları için öngördürücü bir faktör olduğu belirlendi (3.992; %95 güven aralığı [GA]: 1.54-10.35; p=0.004). Yüksek intraoperatif kan kaybı grubundaki ameliyat sonrası akciğer komplikasyonlarının oranı, düşük intraoperatif kan kaybı grubundakinden anlamlı düzeyde daha yüksekti (sırasıyla, %13.9’a kıyasla %37.5; p=0.003). Yüksek intraoperatif kan kaybı grubunda ameliyat sonrası yatış süresi ve ameliyat sonrası antibiyotik kullanım süresi anlamlı düzeyde daha uzundu. Sonuç: İntraoperatif kan kaybı, küçük hücreli dışı akciğer kanseri için akciğer rezeksiyonunun ardından ameliyat sonrası akciğer komplikasyonları için önemli bir risk faktörüdür. Cerrahlar, daha iyi cerrahi sonuçlar için intraoperatif kan kaybını azaltmaya çalışmalıdır.

Effect of intraoperative blood loss on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic surgery

Background: We aimed to investigate the impact of intraoperative blood loss on postoperative pulmonary complications in patients who underwent video-assisted thoracoscopic lobectomy for non- small cell lung cancer. Methods: Data of a total of 409 patients (227 males, 182 females; median age: 62 years; range, 20 to 86 years) who underwent lung resection for Stage I-IIIa non-small cell lung cancer in our clinic between July 2017 and April 2018 were retrospectively analyzed. The receiver operating characteristic analysis was used to confirm the threshold value of intraoperative blood loss for the prediction of postoperative pulmonary complications. Propensity score matching was performed to compare between high-intraoperative blood loss and low-intraoperative blood loss groups. A post-matching conditional logistic regression was conducted to determine the independent risk factors for postoperative pulmonary complications. Results: Of the patients, 86 (21.03%) developed postoperative pulmonary complications. In the propensity score matching analysis, intraoperative blood loss was shown to be a predictive factor of postoperative pulmonary complications (3.992; 95% confidence interval [CI]: 1.54-10.35; p=0.004). The rate of postoperative pulmonary complications in high-intraoperative blood loss group was significantly higher than that the low-intraoperative blood loss group (37.5% vs. 13.9%, respectively; p=0.003). The postoperative length of stay and duration of postoperative antibiotic use were significantly prolonged in the high-intraoperative blood loss group. Conclusion: Intraoperative blood loss serves as a significant risk factor for postoperative pulmonary complications after lung resection for non-small cell lung cancer. Surgeons should strive to reduce intraoperative blood loss for better surgical outcomes.

PDF

___

1. Altorki NK, Markowitz GJ, Gao D, Port JL, Saxena A, Stiles B, et al. The lung microenvironment: An important regulator of tumour growth and metastasis. Nat Rev Cancer 2019;19:9-31.
2. Yan TD, Cao C, D'Amico TA, Demmy TL, He J, Hansen H, et al. Video-assisted thoracoscopic surgery lobectomy at 20 years: A consensus statement. Eur J Cardiothorac Surg 2014;45:633-9.
3. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Non-Small Cell Lung Cancer Version 2. 2018. National Comprehensive Cancer Network. 2017. Available at: https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.
4. Zhi XY, Yu JM, Shi YK. Chinese guidelines on the diagnosis and treatment of primary lung cancer (2015 version). Cancer 2015;121 Suppl 17:3165-81.
5. Lugg ST, Agostini PJ, Tikka T, Kerr A, Adams K, Bishay E, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax 2016;71:171-6.
6. Agostini P, Cieslik H, Rathinam S, Bishay E, Kalkat MS, Rajesh PB, et al. Postoperative pulmonary complications following thoracic surgery: Are there any modifiable risk factors? Thorax 2010;65:815-8.
7. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature 2008;454:436-44.
8. Sezen CB, Kocatürk Cİ. Videothoracoscopic lobectomy training in non-small cell lung cancer. Turk Gogus Kalp Dama 2019;27:199-205.
9. Liu L, Mei J, He J, Demmy TL, Gao S, Li S, et al. International expert consensus on the management of bleeding during VATS lung surgery. Ann Transl Med 2019;7:712.
10. Ghosh SK, Roy S, Daskiran M, Yoo A, Li G, Fegelman EJ. The clinical and economic burden of significant bleeding during lung resection surgery: A retrospective matched cohort analysis of real-world data. J Med Econ 2016;19:1081-6.
11. Szwerc MF, Landreneau RJ, Santos RS, Keenan RJ, Murray GF. Minithoracotomy combined with mechanically stapled bronchial and vascular ligation for anatomical lung resection. Ann Thorac Surg 2004;77:1904-9.
12. Asamura H, Suzuki K, Kondo H, Tsuchiya R. Mechanical vascular division in lung resection. Eur J Cardiothorac Surg 2002;21:879-82.
13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
14. Im Y, Park HY, Shin S, Shin SH, Lee H, Ahn JH, et al. Prevalence of and risk factors for pulmonary complications after curative resection in otherwise healthy elderly patients with early stage lung cancer. Respir Res 2019;20:136.
15. DʼAndrilli A, Cavaliere I, Maurizi G, Andreetti C, Ciccone AM, Ibrahim M, et al. Evaluation of the efficacy of a haemostatic matrix for control of intraoperative and postoperative bleeding in major lung surgery: A prospective randomized study. Eur J Cardiothorac Surg 2015;48:679-83.
16. Mizuno A, Kanda M, Kobayashi D, Tanaka C, Iwata N, Yamada S, et al. Adverse effects of intraoperative blood loss on long-term outcomes after curative gastrectomy of patients with stage II/III gastric cancer. Dig Surg 2016;33:121-8.
17. Bruns CJ, Schäfer H, Wolfgarten B, Engert A. Effect of intraoperative blood loss on the function of natural killer cells in tumors of the upper gastrointestinal tract. Langenbecks Arch Chir Suppl Kongressbd 1996;113:146-9.
18. Arslantas MK, Kara HV, Tuncer BB, Yildizeli B, Yuksel M, Bostanci K, et al. Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections. J Thorac Cardiovasc Surg 2015;149:314-20, 321.e1.
19. Nakamura H, Saji H, Kurimoto N, Shinmyo T, Tagaya R. Impact of intraoperative blood loss on long-term survival after lung cancer resection. Ann Thorac Cardiovasc Surg 2015;21:18-23.
20. Rahouma M, Kamel M, Ghaly G, Nasar A, Harrison S, Stiles B, et al. PS01.45: Intraoperative blood loss is an independent predictor of poor disease free survival for patients undergoing VATS lobectomy for lung cancer. Journal of Thoracic Oncology 2016;11:S297.
21. Grande B, Oechslin P, Schlaepfer M, Seifert B, Inci I, Opitz I, et al. Predictors of blood loss in lung transplant surgery-a single center retrospective cohort analysis. J Thorac Dis 2019;11:4755-61.
22. Wang T, Luo L, Huang H, Yu J, Pan C, Cai X, et al. Perioperative blood transfusion is associated with worse clinical outcomes in resected lung cancer. Ann Thorac Surg 2014;97:1827-37.
23. Latif MJ, Tan KS, Molena D, Huang J, Bott MJ, Park BJ, et al. Perioperative blood transfusion has a dose-dependent relationship with disease recurrence and survival in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg 2019;157:2469-77.e10