Pulmonary vein stump thrombosis after lung resection for lung cancer: clinical features and outcome

Abstract

Pulmonary vein stump thrombosis (PVST) is uncommonly encountered postoperative in-situ thrombosis in the stump of pulmonary veins after lung resection. Data regarding the incidence and clinical behaviour of PVST are scarce. Thus, this study aims to investigate the incidence, clinical characteristics and outcome of PVST after lung resection in patients with lung cancer. Follow-up enhanced chest computed tomography (CT) scans acquired after the surgery were retrospectively reviewed to determine PVST presence for patients with lung cancer who underwent lung resection in two tertiary referral centres. Out of the 1885 patients with lung cancer who underwent lobectomy or more extensive lung resection, PVST was observed in 37 patients (2.0%) on their follow-up chest CT. Most stump thrombi were observed in the left superior pulmonary vein [35 (94.6%)] and in patients who underwent left upper lobectomy [34 (91.9%)]. At the last CT follow-up of each patient, 33 (89.2%) exhibited complete resolution, three partial resolution and one stabilization. Eleven (29.7%) patients received anticoagulant therapy after the diagnosis. The rate of complete PVST resolution did not differ significantly between the anticoagulation and nonanticoagulation groups. None of the PVST patients experienced systemic embolic events, regardless of anticoagulation. The PVST incidence diagnosed at routine chest CT follow-up following lung cancer surgery was 2%. PVST was characterized by a benign clinical course without progression and systemic embolization, regardless of anticoagulation. However, further studies are required to determine individualized therapeutic strategies, including anticoagulation.

The pulmonary-vascular-stump filling defect on CT post lung tumor resection: a predictor of cancer progression

“…Even though these filling defects were considered clots, there has always been significant controversy regarding the necessity of anticoagulant therapy [ 13 – 15 ]. In our study, there was no statistically significant difference in the regression rates of filling defects between the anticoagulant group and the non-anticoagulant group, which is consistent with previous studies [ 4 , 6 ]. While, out of 16 cases receiving anticoagulant therapy, adverse reactions associated with anticoagulant therapy included two cases of gastrointestinal bleeding, one case of cerebral hemorrhage.…”

“…Since the majority of the pulmonary-vascular-stump filling defects were thrombi, previous studies primarily focused on investigating the prognosis of thrombi themselves. Corresponding research results indicate an extremely low probability of secondary pulmonary embolism and conclude the benign natural history of thrombus [ 1 , 5 , 6 ]. However, the relationship between the appearance of thrombi, indicative of a hypercoagulable state, and the progression of tumors, was neglected.…”

“…With the increasing number of lung cancer surgeries, the detection rate of filling defects in the postoperative pulmonary vascular stump has risen, with reported prevalence ranging from 1.9 to 12.4% [ 1 – 7 ]. According to limited study reports, these defects are often considered as intravascular clots with a benign natural history [ 1 , 5 , 6 ]. In fact, we cannot dismiss the potential for malignancy in these defects, which may indicate vascular stump recurrence in cancer patients.…”

Enhanced Recovery after Surgery (ERAS) in Postoperative Lung Cancer Patients: A Novel Perioperative Strategy for Preventing Venous Thromboembolism and Improving Quality of Life

“…Surgery in cancer patients carries a 2-to 3-fold elevated risk of post-operative DVT and PE compared to non-cancer patients undergoing similar procedures (Agnelli et al 2006). Lung cancer, known as primary bronchogenic carcinoma, arises from malignant changes in the bronchi's epithelial lining (Park et al 2022), predominantly impacting elderly males, with non-small cell lung cancer (NSCLC) constituting around 80%-85% of cases (Abdel-Razeq et al 2023). Notably, data from 2018 global cancer statistics highlighted the prevalence of lung cancer, constituting 11.6% of the 18.1 million newly diagnosed cancer cases (Freddie et al 2018).…”