49 - Freie Mitteilung
Clinical works II
16. Mai 2019, 10:15 - 11:45, Bellavista 2, 6. OG
Anatomical lung resections in emergency/urgent setting
E. M. Minerva, M. Patella, R. Pini, S. Cafarotti, R. Inderbitzi, Presenter: E. M. Minerva (Bellinzona)
Emergency and urgent lung resections are performed quite rarely for life-threatening conditions. Indications might be massive hemoptysis or infection, with underlying disease being either benign or malignant. In the latter case, the aim of resection might not be curative for the primary disease, but it attempts to stabilize patients clinical conditions and permits further treatments. It is considered high risk surgery with substantial rate of morbidity and mortality. We report our single centre experience.
We retrospectively evaluated the records, collected in a prospective database, of 10 patients who underwent anatomical lung resection in emergency/urgent setting, between January 2017 and December 2018. Baseline characteristics, surgical factors, and postoperative outcomes were analyzed.
Surgical indication was hemoptysis in 6 cases and infection (necrotizing pneumonia, lung abscess) in 4. Two patients were operated in emergency setting and 8 as urgent cases (<24h). Ratio between male and female was 6:4, mean age was 67 years. On average, patients with lung cancer diagnosis were more complex (higher Charlson Comorbidity Index and American Society of Anesthesiologists score). One operation was performed with minimally invasive approach and 9 with open thoracotomy. Extension of lung resection was: 1 pneumonectomy, 7 lobectomies and 2 segmentectomies. Median post-surgical length of stay was 9 days (range 2-22), median intercostal tube duration was 3.5 days (range 1-7). Two major cardiopulmonary complications according to the European Society of Thoracic Surgeons were recorded: 1 pulmonary embolism and 1 atelectasis requiring bronchoscopy. No surgical complications occurred except for 1 wound infection. No cases of prolonged air leak were recorded. In-hospital and 30-days mortality was 0. Final histology showed 4 squamous cell carcinomas, 2 adenocarcinomas, 1 carcinoid tumor, 1 vascular malformation, 1 tubercular caverna and 1 aspergillus.
Emergency and urgent anatomical lung resections are life-saving procedures that, although high-risk, show acceptable morbidity. The short term results reported, also with a minimally invasive approach, are encouraging. In case of primary lung cancer as underling disease, even outside standard oncological indications, they can resolve hyperacute onset of symptoms, allowing further implementation of optimal systemic treatments.