Postoperative complications and perioperative management in patients on hemodialysis undergoing lung resection
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ORIGINAL ARTICLE
Postoperative complications and perioperative management in patients on hemodialysis undergoing lung resection Yukio Watanabe1 · Aritoshi Hattori1 · Mariko Fukui1 · Takeshi Matsunaga1 · Kazuya Takamochi1 · Shiaki Oh1 · Kenji Suzuki1 Received: 13 July 2020 / Accepted: 6 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives The rate of lung resection in patients on hemodialysis (HD) is increasing with the increasing number of HD. However, studies assessing lung resection in HD are limited. The study aimed to investigate the perioperative management and postoperative complications of lung resection in HD patients. Methods Between 2007 and 2019, of the 4989 patients underwent lung resection, 43 patients had been receiving HD. We compared the characteristics of a Clavien–Dindo classification grade ≥ 2 group against grade ≤ 1 group. Predictive factors of complications were analyzed by logistic regression analysis. Results Thirty-three patients were men (median age: 69 years). Thirty-eight patients had lung cancer. The reason for HD was diabetic nephropathy in 19 patients, nephrosclerosis in 10, and miscellaneous in 14. The median duration of HD before surgery was 64.6 months. The type of lung resection was lobectomy in 24, segmentectomy in 10, and partial resection in 9 patients. Bronchial calcification was detected in 16 (37%). Reinforcement at the stump was performed in 9 lobectomies, of which 6 involved bronchial calcification. Postoperative complications were detected in 21 (49%), including grade ≥ 2 complications in 14 (33%). Multivariate analysis revealed that pack-year smoking ≥ 10 (p = 0.01) and operation time ≥ 140 min (p = 0.02) were predictors of grade ≥ 2 morbidity. Conclusions Heavy smoking and longer operative time may result in postoperative complication requiring therapeutic intervention. The frequency of bronchial calcification is relatively high in HD patients, and reinforcement of the calcified bronchial stump should be considered during lobectomy. Keywords Hemodialysis · Lung resection · Postoperative complication · Perioperative management
Introduction The number of end-stage renal disease patients on hemodialysis (HD) is increasing due to improvement in the prognosis attributed to medical advances and changes in trends regarding the cause of mortality [1, 2]. The incidence of cardiovascular disease, which is the leading cause of death for HD patients, has decreased in these patients. In contrast, the incidence of other diseases, including infectious or malignant diseases, is increasing [2]. Particularly for lung cancer, chemotherapy has not been routinely administered * Kenji Suzuki [email protected] 1
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1‑3 Hongo 3‑chome, Bunkyo‑ku, Tokyo 113‑8431, Japan
to such patients [3], and no effective regimen or guidelines are currently available. Therefore, it is reasonable to anticipate an increasing number of HD patients with lung cancer who require surgery.
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