Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor

Abstract

Background In this study, we aimed to summarize the extremely important lesson and experience in the whole process of surgical treatments of lung tumors for the benefit of steps taken to prevent against unplanned reoperation. Methods Demographical and clinical information of 7732 patients were retrospectively retrieved and reviewed, who were diagnosed with pulmonary tumor and underwent surgical treatments from January 2016 to March 2021. Those patients who underwent unplanned reoperation for the treatment of severe complications were focused carefully and analyzed meticulously. Results A total of forty-one patients (41/7732) received 44 unplanned reoperations. Among them, eight and thirty-three patients were diagnosed with benign and malignant tumor, respectively. The incidence of unplanned reoperations seemed to be similar on both sides (Left vs. Right: 12/3231 vs. 29/4501, p = 0.103). Lobectomy plus segmentectomy is prone to reoperation (2/16, 12.5%) as compared to the other types of surgery. The complications leading to reoperation was hemothorax, including active hemorrhage (23/44, 52.3%) and clotted hemothorax (6/44, 13.6%), chylothorax (8/44, 18.2%), and the others (7/44, 15.9%) including bronchopleural fistula, torsion, or injury of right middle bronchus and pulmonary bulla rupture. The morbidity and mortality after unplanned reoperation were 17.1% (7/41) and 12.2% (5/41), respectively. Conclusions Bronchi or vessel stumps, the surgical edges of the lung parenchyma, and pleural adhesions should be checked to avoid postoperative bleeding. Prophylactic ligation of the thoracic duct should be recommended in case of the suspected oily-like exudation in the lymph node bed. Smooth expansion of the middle lobe is important to avoid narrowing and torsion before transection of the bronchus.

Usefulness of preoperative ice cream consumption and novel postoperative drainage management in patients undergoing left-sided neck dissection for thyroid cancer: a nonrandomized prospective study

“…However, Wang et al [ 12 ] stated that lymphatic vessel treatment with energy devices is insufficient to prevent chyle leakage. Furthermore, several studies reported chylothorax following endoscopic lung or esophageal cancer resection using certain energy devices; therefore, such devices are not completely reliable [ 13 , 14 ]. Zhang et al [ 15 ] recently reported the usefulness of pedicled omohyoid flap coverings in preventing postoperative lymph node or chyle leakage.…”

Unplanned reoperation after pulmonary surgery: Rate, risk factors and early outcomes at a single center

“…Reoperations are essential interventions for managing severe complications that may arise after surgical procedures. They are rare, but they impose an additional burden on patients and are associated with higher morbidity and mortality rates [ 5 , 7 ]. Our findings corroborate those of previous studies that reported unplanned reoperations as predictors of prolonged hospital stays, increased complications, and reduced short-term survival rates [ 2 , 5 ].…”

“…Dai et al reported that pleural adhesion separation surface and lymph node dissection surface were more prone to bleeding [ 17 ]. Moreover, many studies found unidentified bleeding sites in a large percentage of their cohort [ 6 , 7 ]. Therefore, we recommend careful inspection of all potential bleeding sources before closing the incision, especially the stumps of pulmonary and bronchial vessels, the pulmonary stapling line, and the lymph nodes dissection surface.…”

“…The incidence of unplanned reoperation after lung surgery ranges from 1.01% to 1.09% [ 2 , 5 ], while it varies between 0.27% and 1.76% in lung cancer surgery [ [6] , [7] , [8] ]. One study reported a decreasing trend of reoperation rate over time [ 8 ].…”