Clinical Indicators to Guide Reoperation for Postoperative Hemorrhage After Pulmonary Resection for Malignancy: A Single-Institutional Experience of 22 Cases

Abstract

Kenta Hasumi,1,2 Yukihiro Yoshida,1 Masaya Yotsukura,1 Kazuo Nakagawa,1 Koichi Goto,2 Shun-ichi Watanabe1 1Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan; 2Department of Comprehensive Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JapanCorrespondence: Kenta Hasumi; Yukihiro Yoshida, Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan, Tel [phone], Email [email protected]; [email protected]: This study investigated perioperative clinical information, surgical findings, and postoperative courses of patients who underwent reoperation due to bleeding after the surgery for pulmonary malignancies.Methods: We identified patients who underwent reoperation due to postoperative bleeding from 6989 patients who had had operations for pulmonary malignancies between January 2007 and July 2019. Data were retrospectively collected from medical charts.Results: Twenty-two patients (0.3%) underwent reoperation for hemostasis. The reason for reoperation was a shock state with minimum systolic blood pressure < 90 mm Hg in 12 patients (55%), persistent bloody drainage of 100 mL/h or more in 15 patients (68%), and intrathoracic hematoma on a chest X-ray image in 14 patients (64%). All those three findings were observed in five patients (23%), two in nine patients (41%), and one in eight patients (36%). The source of bleeding could not be identified during reoperation in four patients (18%). In the regression analysis, the coefficient of determination between the amount of drainage from a chest drain and the volume of intrathoracic hematoma found during reoperation was 0.31, indicating poor correlation. Postoperative complications and death occurred in two (9%) and zero patients, respectively.Conclusion: Reoperation due to bleeding is required in certain cases. The amount of drainage from a chest drain does not necessarily reflect the volume of intrathoracic hematoma and it is hard to estimate the total amount of bleeding. The decision to perform reoperation for hemostasis should be comprehensively made on the basis of clinical signs and chest X-ray findings.Keywords: bleeding, hemostasis, lung neoplasms, thoracic surgery, intraoperative complications, reoperation

Keywords

• bleeding
• hemostasis
• lung neoplasms
• thoracic surgery
• intraoperative complications
• reoperation