Frequency of multiple primary cancers in the lung and other organs in hemodialysis patients

Postoperative complications and perioperative management in patients on hemodialysis undergoing lung resection

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.

Outcomes, safety, and feasibility of video-assisted thoracic surgery in lung cancer patients on hemodialysis: a case series

OBJECTIVE

The rate of surgical resection of lung cancer in patients on hemodialysis is expected to increase due to the development of hemodialysis, improved diagnosis of lung cancer, and increases in the number and age of patients. However, studies assessing outcomes of lung resection in these patients are limited. In this retrospective case series, we investigated the safety and efficacy of video-assisted thoracic surgery (VATS) for lobectomy or segmentectomy for lung cancer in patients on hemodialysis.

METHODS

Between January 2010 and January 2017, lobectomy or segmentectomy using VATS was performed for seven lung cancer cases in six patients receiving hemodialysis at our institution. There were two female and five male patients, with a median age of 61 years (range 53-76 years). Six patients underwent lobectomy, and segmentectomy and wedge resection were performed in each one case, respectively; systematic mediastinal lymph node dissection (ND2a-2) was performed in six patients.

RESULTS

There were no perioperative deaths in this case series. Median recurrence-free and overall survival rates were 20 months (range 3-82 months) and 31 months (range 3-82 months), respectively.

CONCLUSIONS

Video-assisted thoracic surgery (VATS) is a safe and effective procedure for resection of lung cancer in hemodialysis patients and should be considered after accurate determination of surgical indications and careful perioperative management.