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Objective:To identify the characteristics of venous thromboembolism(VTE) after lung surgery and the use of prophylactic anticoagulants. Inclusion criteria: (1) patients with primary pulmonary disease; (2) received pulmonary surgery; (3) Doppler ultrasound examination of lower extremity veins before and after operation.Methods:Patients who underwent lung surgery in our department from July 2016 to December 2017 were studied retrospectively.Results:A total of 659 patients who underwent lung surgery were analyzed, of which 58 patients had new diagnosis of VTE, after surgery with an incidence of 8.8%, and 151 patients were treated with prophylactic anticoagulants, with a total prophylactic use rate of 22.9%. According to the modified Caprini risk assessment scale, the patients were divided into three groups: low risk group(≤4 points), medium risk group(5-8 points) and high risk group(≥9 points). The proportion of prophylactic anticoagulation in each group was 4.0%(12/300), 36.3%(119/328) and 64.5%(20/31), respectively. The duration of prophylactic anticoagulation was also quite different, including 99 patients with anticoagulation for 1-3 days, 46 for 4-6 days, and 6 for 7-9 days. There was no significant difference in the incidence of VTE between patients who received prophylactic anticoagulation and patients who did not receive prophylactic anticoagulation( P>0.05). Conclusion:The incidence of VTE after pulmonary surgery is high, but the proportion of patients receiving prophylactic anticoagulation is low, and the anticoagulation course is too short, which leads to the poor preventive effect. It is suggested that the use of anticoagulants should be reasonably standardized in the future in order to improve the state of blood coagulation and prevent thrombosis.
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Objective:To investigate the characteristics and clinical significance of lymph node metastasis of peripheral non-small cell lung cancer(NSCLC) with diameter ≤ 2 cm; to explore the possibility of regional mediastinal lymphadenectomy.Methods:Collect all patients’ data with peripheral NSCLC ≤2 cm from January 2017 to August 2018 in our hospital, there was no previous history of other malignant tumors. All patients underwent lobectomy, segmentectomy, or wedge resection, and mediastinal lymphadenectomy , and comprehensive analysis was performed based on pathological findings and clinical features.Results:Among the peripheral NSCLC with a diameter of ≤ 2 cm, metastatic degree and rate of mediastinal lymph nodes were low(0.67% and 1.87%, respectively). The lymph nodes metastatic rate of pGGO, mGGO and solid nodule were 0, 1.18% and 4.92%, respectively. The 11th group of lymph node metastasis was positively correlated with the solid components of lymph nodules( P=0.024). While lymph node metastasis had no significant correlation between gender, age, smoking history, size, location, and tumor type. The metastasis of the 11th group of lymph nodes was positively correlated with the 2nd, 3rd, 4th and 6th lymph nodes( P=0.014, Kappa value 8.406). Conclusion:For the operation of pGGO patients, mediastinal lymphadenectomy was not necessary, or maybe N1 lymph nodes sampling was enough. For the operation of mGGO or solid nodules, the surgeon can determine the lymphadenectomy scope according to the 11th-group lymph nodes frozen pathology result. If positive, the extent of lymph node dissection should be appropriately expanded; If negative, the lymph node dissection can be skipped, so as to reduce the complications.
ABSTRACT
Venous thromboembolism (VTE) is a common perioperative complication of lung cancer and a major cause of unexpected death in hospital. The clinical risk factors of VTE include: patients' factors (advanced age, obesity, etc.), tumor-related factors (classification, staging, etc.), treatment-related factors (chemotherapy, surgery, etc.). In addition, tumor cells express cancer procoagulant (CP), tissue factor (TF), inflammatory factors or activate platelets, inflammatory cells and other related cells, directly or indirectly activate the coagulation process, and cause blood hypercoagulable state, thus promote the occurrence of VTE. At the same time, the relevant biomarkers can also reflect the perioperative coagulation status of patients, which is helpful to more accurately identify high-risk subgroups to establish more accurate and targeted anticoagulation strategies to prevent thrombosis in lung cancer patients.
ABSTRACT
BACKGROUND@#The Previous study has indicated that the incidence of venous thromboembolism (VTE) after lung cancer surgery is not uncommon. The aim of this study is to analyze the risk factors of postoperative VTE in lung cancer patients and provide a clinical basis for further prevention and treatment of VTE.@*METHODS@#This study was a single-center study. From July 2016 to December 2017, all patients with lung cancer who underwent surgery in our department were enrolled into this study. Except routine preoperative examinations, lower extremity Doppler ultrasound was performed in all patients before and after surgery to determine whether there was any newly developed deep venous thrombosis (DVT). Patients did not receive any prophylactic anticoagulant therapy before and after surgery. Patients were then divided into VTE group and control group according to whether VTE occurred after operation. Baseline data, surgical related data (surgery type, surgical procedure, etc.) and tumor pathological data (pathological type, vascular infiltration, pathological staging, etc.) were compared between the two groups.@*RESULTS@#According to the inclusion criteria, a total of 339 patients undergoing lung cancer surgery were analyzed. There were 166 males and 173 females with an age range of 23-86 years. A total of 39 patients developed VTE after surgery, the incidence rate of postoperative VTE was 11.5%. Comparing the age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA), smoking status, underlying diseases, etc, there were no significant differences in other indicators except for significant differences in age; comparison between preoperative blood routine, blood biochemistry, coagulation, tumor markers, lung function, lower extremity venous ultrasound, preoperative carcinoembryonic antigen (CEA) levels, preoperative D-dimer levels, there were significant differences in lung function and lower extremity intermuscular vein expansion ratio. There were no significant differences in other indexes between the two groups. The duration of surgery, surgical procedure, bleeding volume, pathological type, pathological stage, vascular invasion, were compared between the two groups. There were statistical differences in surgical methods (thoracic vs thoracoscopic) and bleeding volume. There were no significant differences in other indicators. Univariate analysis showed that age, preoperative CEA level, preoperative D-dimer level, poor pulmonary function, lower extremity intermuscular vein dilation ratio, thoracotomy rate, length of surgery, and amount of bleeding were significantly risk factors (P<0.05). There were no significant correlations between pathological stage and pathological type and VTE. Multivariate logistic regression analysis showed that forced expiratory volume in one second (FEV1), surgical approach, and lower extremity intermuscular vein dilatation were independent risk factors for postoperative VTE in patients with lung cancer (P<0.05).@*CONCLUSIONS@#The results of this study suggest that FEV1, surgical procedures, and lower extremity intermuscular vein dilation are independent risk factors for postoperative VTE in patients with lung cancer.