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Resection of Lung Cancer with Left Atrium Extension via the Pulmonary Vein: Case Report

Open Journal of Thoracic Surgery 2018年第1期8卷 13-18页

作者： Shinjiro Mizuguchi Nobuhiro Izumi Hiroaki Komatsu Michihito Toda kantaro hara Toshihiko Shibata Noritoshi Nishiyama Department of Thoracic Surgery Osaka City University Hospital Osaka Japan

A 49-year-old man had an abnormal shadow on chest X-ray. Enhanced chest computed tomography (CT) revealed an 8-cm diameter right lung mass invading the right chest wall, with a tumor thrombus extending from the superior pulmonary vein into the left atrium. Transesophageal echocardiography confirmed that the tumor adjoined the side wall of the atrium. Endobronchial and CT-guided needle biopsy demonstrated a low-grade carcinoma or small cell carcinoma. Operative findings through left atriotomy under cardiopulmonary bypass showed no tumor invasion of the atrium wall, but protrusion through the pulmonary vein. Frozen sections revealed a non-small cell carcinoma. We performed right upper lobectomy with parietal pleura and mediastinal lymph node dissection after detachment of cardiopulmonary bypass. Pathological examination demonstrated a large-cell neuroendocrine carcinoma p-T4N0M0, stage IIIA. The patient recovered without postoperative complications and tolerated two cycles of adjuvant chemotherapy. He was doing well without symptoms of recurrence 42 months after surgery.

关键词： Extensive Invasion Left Atrium Lung Cancer Cardiopulmonary Bypass

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Relationship between Perioperative N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) and Complications in Thoracic Surgery

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Open Journal of Thoracic Surgery 2018年第2期8卷 29-36页

作者： kantaro hara Takuma Tsukioka Nobuhiro Izumi Kyukwang Chung Hiroaki Komatsu Michihito Toda Hikaru Miyamoto Satoshi Suzuki Takuya Kimura Toshihiko Shibata Noritoshi Nishiyama Department of Thoracic Surgery Osaka City University Hospital Osaka Japan

Background: In cardiac surgery, the N-terminal pro-brain natriuretic peptide (NT-proBNP) level is reportedly correlated with the onset of postoperative complications. We examined the relationship between the NT-proBNP level and perioperative complications in thoracic surgery and elucidated the significance of NT-proBNP measurement. Methods: We evaluated 48 patients excluding hemodialysis patients who underwent lung resection from November 2015 to February 2016. NT-proBNP measurement was performed three times preoperatively on postoperative days 2 and 5. We examined the relationship between clinical background factors such as preoperative comorbidity and the development of postoperative complications. Based on established criteria for surgical complications (Clavien-Dindo classification), grade ≥ II was defined as a complications. We classified the patients into two groups (with or without complications) and compared and examined the background factors between the groups. Results: The study included 48 patients (33 male, 15 female) with an average age of 72 years (range, 35 - 86 years). Preoperative comorbidities included cardiovascular disease in five patients, diabetes mellitus in four, and chronic obstructive pulmonary disease in six. The average operation time was 163 (29 - 308) minutes, and the bleeding volume was 30 (10 - 620) ml. Early complications were confirmed in 11 patients, and late complications were confirmed in 7 patients. A high NT-proBNP level on postoperative day 5 was an independent risk factor for late complications. Conclusion: The perioperative NT-proBNP level is considered to be a predictor of complications. Its measurement is useful for predicting postoperative complications, and careful perioperative management is required for patients with high levels.

关键词： NT-proBNP Perioperative Management Lung Resection Postoperative Complications

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