Diagnosis and Treatment for Acute Pulmonary Embolism after Video-assisted Thoracoscopic Lobectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGZongfei , MA Lunchao , XIONG Xinguo

Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical College, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, P. R. China;

Corresponding author：

Keywords：

Lung cancer; Pulmonary embolism; Lobectomy; Video-assisted thoracoscopic surgery

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Abstract： Objective To investigate strategies for prevention，early diagnosis，and prompt treatment for acute pulmonary embolism（PE）after video-assisted thoracoscopic surgery（VATS）lobectomy. Methods From January 2007 to November 2010, 1 115 patients with lung cancer underwent VATS lobectomy in the First Affiliated Hospital of Guangzhou Medical College. Among them, 13 patients had acute PE postoperatively, including 6 male patients and 7 female patients with their mean age of 62.3 years（ranging from 42 to 73 years）.All the patients were diagnosed by spiral CT pulmonary artery angiography（SCTPA）, and received anticoagulation therapy with low molecular weight heparin and warfarin. Results The incidence of acute PE after VATS lobectomy was 1.17%（13/1 115）, and the patients with low PE-related early mortality risk accounted for a large proportion（11/13）. There were 12 patients with right-side PE. All the patients’ signs and symptoms were significantly alleviated after administration of anticoagulation therapy. Nine patients received SCTPA review after treatment which showed that their PE had disappeared or been significantly absorbed. No hematological complications including thoracic hemorrhage or wound errhysis occurred after treatment. All surviving patients were followed up for 1 month to 3 months. During follow-up, these patients were alive without PE recurrence. Conclusion SCTPA is the first-choice examination for the diagnosis of acute PE after VATS lobectomy. Prophylaxis against PE and prompt treatment are necessary depending on individual manifestations. VATS lobectomy should be favored as a minimally invasive surgical treatment for patients with lung cancer, for the low incidence of postoperative PE and low PE-related early mortality risk.

Citation： WANGZongfei,MA Lunchao,XIONG Xinguo,et al .. Diagnosis and Treatment for Acute Pulmonary Embolism after Video-assisted Thoracoscopic Lobectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(2): 136-140. doi: Copy

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13.	Sөrensen HT, Horvath-Puho E, Pedersen L, et al. Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events： a 20-year cohort study. Lancet, 2007, 370（9601）：1773-1779.
14.	Kalweit G, Huwer H, Volkmer I, et al. Pulmonary embolism： a frequent cause of acute fatality after lung resection. Eur J Cardiothorac Surg, 1996, 10（4）：242-247.
15.	Kwek BH, Wittram C. Postpneumonectomy pulmonary artery stump thrombosis： CT features and imaging follow-up. Radiology, 2005, 237（1）：338-341.
16.	Isik F, Kara M, Tuncogur B, et al. Significance of ligature technique on the formation of pulmonary artery stump thrombosis in a canine model. Acta Chir Belg, 2005, 105（2）：203-206.
17.	Kearon C, Kahn SR, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease： American College of Chest Physicians Evidence-Based Clinical Practice Guidelines （8th Edition）. Chest, 2008, 133（6 Suppl）：454S-545S.
18.	Sakuragi T, Sakao Y, Furukawa K, et al. Successful management of acute pulmonary embolism after surgery for lung cancer. Eur J Cardiothorac Surg, 2003, 24（4）：580-587.

1. 　Kilic D, Akin S, Findikcioglu A, et al. Low-molecular-weight heparin for treatment of submassive pulmonary embolism after pneumonectomy. Gen Thorac Cardiovasc Surg, 2007, 55（7）：287-289.
2. 　Wells PS, Anderson DR, Rodger M , et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism： increasing the models utility with the SimpliRED D-dimer. Thromb Haemost, 2000, 83（3）：：416-420.
3. 　Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism： The task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology （ESC）. Eur Heart J, 2008, 29（18）：2276-2315.
4. 　Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med, 2010, 363（3）：266-274.
5. 　Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol, 2009, 27（15）：2553-2562.
6. 　Ziomek S, Read RC, Tobler HG, et al. Thromboembolism in patients undergoing thoracotomy. Ann Thorac Surg, 1993, 56（2）：223-226.
7. 　Nagahiro I, Andou A, Aoe M, et al. Intermittent pneumatic compression is effective in preventing symptomatic pulmonary embolism after thoracic surgery. Surg Today, 2004, 34（1）：6-10.
8. 　Nagahiro I, Watanuki Y, Sato S, et al. Venous velocity of the right femoral vein decreases in the right lateral decubitus position compared to the supine position： a cause of postoperative pulmonary embolism? Acta Med Okayama, 2007, 61（2）：57-61.
9. 　Sostman HD, Stein PD, Gottschalk A, et al. Acute pulmonary embolism： sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology, 2008, 246（3）：941-946.
10. 　Stein PD, Fowler SE, Goodman LR, et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med, 2006, 354（22）：2317-2327.
11. 　Wan S, Quinlan DJ, Agnelli G, et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism： A meta-analysis of the randomized controlled trials. Circulation, 2004, 110（6）：744-749.
12. 　Aujesky D, Roy PM, Verschuren F, et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism： an international, open-label, randomised, non-inferiority trial. Lancet, 2011, 378（9785）：41-48.
13. 　Sөrensen HT, Horvath-Puho E, Pedersen L, et al. Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events： a 20-year cohort study. Lancet, 2007, 370（9601）：1773-1779.
14. 　Kalweit G, Huwer H, Volkmer I, et al. Pulmonary embolism： a frequent cause of acute fatality after lung resection. Eur J Cardiothorac Surg, 1996, 10（4）：242-247.
15. 　Kwek BH, Wittram C. Postpneumonectomy pulmonary artery stump thrombosis： CT features and imaging follow-up. Radiology, 2005, 237（1）：338-341.
16. 　Isik F, Kara M, Tuncogur B, et al. Significance of ligature technique on the formation of pulmonary artery stump thrombosis in a canine model. Acta Chir Belg, 2005, 105（2）：203-206.
17. 　Kearon C, Kahn SR, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease： American College of Chest Physicians Evidence-Based Clinical Practice Guidelines （8th Edition）. Chest, 2008, 133（6 Suppl）：454S-545S.
18. 　Sakuragi T, Sakao Y, Furukawa K, et al. Successful management of acute pulmonary embolism after surgery for lung cancer. Eur J Cardiothorac Surg, 2003, 24（4）：580-587.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis and Treatment for Acute Pulmonary Embolism after Video-assisted Thoracoscopic Lobectomy

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