Cerebral Infarction After Lobectomy for Lung Cancer

Hiroyuki Miura; Jun Miura; Hiroshi Hirano

doi:doi:10.11648/j.js.20190703.13

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Cerebral Infarction After Lobectomy for Lung Cancer

Hiroyuki Miura, Jun Miura, Hiroshi Hirano

Published in Journal of Surgery (Volume 7, Issue 3)

Received: 22 April 2019 Accepted: 28 May 2019 Published: 10 June 2019

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Abstract

Background and objective: The left upper lobectomy as treatment for lung cancer has been identified as a risk factor for cerebral infarction. We analyzed cases of surgery for lung cancer to clarify factors that increase the risk for postoperative cerebral infarction. Methods: This study included patients with primary lung cancer who underwent lobectomy or segmentectomy with >ND1 lymph node dissection from 2008 to 2014 at Hachioji Medical Center of Tokyo Medical University. In total, 479 patients (294 males and 157 females) were examined. Cases of cerebral infarction occurring within 30 days of surgery were retrospectively studied. All surgeries were performed under mini-thoracotomy with thoracoscopy support. Vessels >7 mm in diameter were amputated using a linear stapler. Results: Cerebral infarction occurred in four male patients, representing 0.8% (4/479) of all lung cancers and 1.4% (4/294) of all male patients. Of these four patients, three were in their 60s (1.4% of 157 patients in their 60s) and one was in his 70s (0.5% of 215 patients in their 70s). Two cases involved adenocarcinomas, and two involved squamous cell carcinomas. One patient underwent right upper lobectomy, two underwent right lower lobectomy, and one underwent left upper lobectomy. The cerebral infarctions occurred in a branch of the vertebral artery. The pons was impaired in three cases, and the cerebellum was impaired in one. Three patients had pl2 disease, and one patient had pl3 disease. Operative time was 4–5 h in two cases, 5–6 h in one, and >6 h in one. Only pl factor significantly differed between patients with and without postoperative cerebral infarction. Conclusions: To prevent cerebral infarction, the following factors should be considered: preoperative smoking cessation, operative positioning to protect the vertebral artery, shortening of operative time, and stronger anticoagulant therapy for high-risk patients, such as those with past history of transient ischemic attack.

Published in	Journal of Surgery (Volume 7, Issue 3)
DOI	10.11648/j.js.20190703.13
Page(s)	63-66
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Cerebral Infarction, Lobectomy, Lung Cancer, Lymph Node Dissection, Pulmonary Vein Thrombosis

References

[1]	Yamamoto T, Suzuki H, Nagato K, Nakajima T, Iwata T, Yoshida S, Yoshino I. Is left upper lobectomy for lung cancer a risk factor for cerebral infarction? Surg. Today. 2016; 46: 780–4.
[2]	Miyoshi R, Nishikawa S, Tamari S, Noguchi M, Hijiya K, Chihara K. Pulmonary vin thrombosis after lobectomy with vein stump closure by ligation. Asian cardiovasc Thorac Ann. 2018; 26: 546-551.
[3]	Kobayashi Y, Yashikozawa H, Takamatsu R, Watanabe R, Hoshi K, Ishii W, Sato S. Left upper lung lobectomy is an embolic risk factor for cerebral infarction. J Storoke Cerebrovasc Dis. 2017; 26: e177-e179.
[4]	Ohtaka K, Hida H, Kaga K, Takahashi Y, Kawase H, Hayama S, Ichimura T, Senmaru N, Honma N, Matsui Y. Left upper lobectomy can be a risk factor for thrombus in the pulmonary vein stump. J Cardiovasc Surg. 2014; 6: 9: 5.
[5]	Usui G, Matsumoto J, Hashimoto H, Katano T, Kusakabe M, Horiuchi H, Okubo S. Thrombus reformation in the pulmonary vein stump confirmed 16 months after cerebral embolism on the day after left upper lobectomy for lung cancer. J Storoke Cerebrovasc Dis. 2018; 27: e225-e227.
[6]	Hattori A, Takamochi K, Kitamura Y, Matsunaga T, Suzuki K, Shiaki Oh, Suzuki K. Risk factor analysis of cerebral infarction and clinicopathological characteristics of left upper pulmonary vein stump thrombus after lobectomy. Gen. Thorac. Cardiovasc. Surg. 2019; 67 (2); 247-253.
[7]	Ohtaka K, Hida Y, Kaga K, Kato T, Muto J, Nakada-Kubota R, Sasaki T, Matsui Y. Thrombosis in the pulmonary vein stump after left upper lobectomy as a possible cause of cerebral infarction. Ann. Thorac. Surg. 2013; 95: 1924–9.
[8]	Ichimura H, Ozawa Y, Nishina H, Shiotani S. Thrombus formation in the pulmonary vein stump after left upper lobectomy: a report of four cases. Ann. Thorac. Cardiovasc. Surg. 2014; 20 Suppl: 613–6.
[9]	Kobayashi Y, Yahikozawa H, Takamatsu R, Watanabe R, Hoshi K, Ishii W, Sato S. Left Upper Lung Lobectomy Is an Embolic Risk Factor for Cerebral Infarction. J. Stroke Cerebrovasc. Dis. 2017; 26 (9); e177-e179.
[10]	Asteriou C, Barbetakis N, Efstathiou A, Kleontas A, Tsilikas C. Renal artery thrombosis following lobectomy for lung cancer. Case Rep Oncol. 2010; 3：08-211.
[11]	Umeda Y, Matsumoto S, Mori Y, Takiya H. Postoperative superior mesenteric artery and cerebral infarction possibly due to the thrombus at the left superior pulmonary vein stump. Kyobu Geka. 2015; 68: 967-969. In Japanese.
[12]	Nakano T, Inaba M, Kaneda H. Recurrent cerebral attack caused by thrombosis in the pulmonary vein stump in a patient with left upper lobectomy on anticoagulant therapy: case report and literature review. Surg. Case Rep. 2017; 3: 101.

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APA Style

Hiroyuki Miura, Jun Miura, Hiroshi Hirano. (2019). Cerebral Infarction After Lobectomy for Lung Cancer. Journal of Surgery, 7(3), 63-66. https://doi.org/10.11648/j.js.20190703.13

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ACS Style

Hiroyuki Miura; Jun Miura; Hiroshi Hirano. Cerebral Infarction After Lobectomy for Lung Cancer. J. Surg. 2019, 7(3), 63-66. doi: 10.11648/j.js.20190703.13

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AMA Style

Hiroyuki Miura, Jun Miura, Hiroshi Hirano. Cerebral Infarction After Lobectomy for Lung Cancer. J Surg. 2019;7(3):63-66. doi: 10.11648/j.js.20190703.13

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@article{10.11648/j.js.20190703.13,
  author = {Hiroyuki Miura and Jun Miura and Hiroshi Hirano},
  title = {Cerebral Infarction After Lobectomy for Lung Cancer},
  journal = {Journal of Surgery},
  volume = {7},
  number = {3},
  pages = {63-66},
  doi = {10.11648/j.js.20190703.13},
  url = {https://doi.org/10.11648/j.js.20190703.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20190703.13},
  abstract = {Background and objective: The left upper lobectomy as treatment for lung cancer has been identified as a risk factor for cerebral infarction. We analyzed cases of surgery for lung cancer to clarify factors that increase the risk for postoperative cerebral infarction. Methods: This study included patients with primary lung cancer who underwent lobectomy or segmentectomy with >ND1 lymph node dissection from 2008 to 2014 at Hachioji Medical Center of Tokyo Medical University. In total, 479 patients (294 males and 157 females) were examined. Cases of cerebral infarction occurring within 30 days of surgery were retrospectively studied. All surgeries were performed under mini-thoracotomy with thoracoscopy support. Vessels >7 mm in diameter were amputated using a linear stapler. Results: Cerebral infarction occurred in four male patients, representing 0.8% (4/479) of all lung cancers and 1.4% (4/294) of all male patients. Of these four patients, three were in their 60s (1.4% of 157 patients in their 60s) and one was in his 70s (0.5% of 215 patients in their 70s). Two cases involved adenocarcinomas, and two involved squamous cell carcinomas. One patient underwent right upper lobectomy, two underwent right lower lobectomy, and one underwent left upper lobectomy. The cerebral infarctions occurred in a branch of the vertebral artery. The pons was impaired in three cases, and the cerebellum was impaired in one. Three patients had pl2 disease, and one patient had pl3 disease. Operative time was 4–5 h in two cases, 5–6 h in one, and >6 h in one. Only pl factor significantly differed between patients with and without postoperative cerebral infarction. Conclusions: To prevent cerebral infarction, the following factors should be considered: preoperative smoking cessation, operative positioning to protect the vertebral artery, shortening of operative time, and stronger anticoagulant therapy for high-risk patients, such as those with past history of transient ischemic attack.},
 year = {2019}
}

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TY - JOUR
T1 - Cerebral Infarction After Lobectomy for Lung Cancer
AU - Hiroyuki Miura
AU - Jun Miura
AU - Hiroshi Hirano
Y1 - 2019/06/10
PY - 2019
N1 - https://doi.org/10.11648/j.js.20190703.13
DO - 10.11648/j.js.20190703.13
T2 - Journal of Surgery
JF - Journal of Surgery
JO - Journal of Surgery
SP - 63
EP - 66
PB - Science Publishing Group
SN - 2330-0930
UR - https://doi.org/10.11648/j.js.20190703.13
AB - Background and objective: The left upper lobectomy as treatment for lung cancer has been identified as a risk factor for cerebral infarction. We analyzed cases of surgery for lung cancer to clarify factors that increase the risk for postoperative cerebral infarction. Methods: This study included patients with primary lung cancer who underwent lobectomy or segmentectomy with >ND1 lymph node dissection from 2008 to 2014 at Hachioji Medical Center of Tokyo Medical University. In total, 479 patients (294 males and 157 females) were examined. Cases of cerebral infarction occurring within 30 days of surgery were retrospectively studied. All surgeries were performed under mini-thoracotomy with thoracoscopy support. Vessels >7 mm in diameter were amputated using a linear stapler. Results: Cerebral infarction occurred in four male patients, representing 0.8% (4/479) of all lung cancers and 1.4% (4/294) of all male patients. Of these four patients, three were in their 60s (1.4% of 157 patients in their 60s) and one was in his 70s (0.5% of 215 patients in their 70s). Two cases involved adenocarcinomas, and two involved squamous cell carcinomas. One patient underwent right upper lobectomy, two underwent right lower lobectomy, and one underwent left upper lobectomy. The cerebral infarctions occurred in a branch of the vertebral artery. The pons was impaired in three cases, and the cerebellum was impaired in one. Three patients had pl2 disease, and one patient had pl3 disease. Operative time was 4–5 h in two cases, 5–6 h in one, and >6 h in one. Only pl factor significantly differed between patients with and without postoperative cerebral infarction. Conclusions: To prevent cerebral infarction, the following factors should be considered: preoperative smoking cessation, operative positioning to protect the vertebral artery, shortening of operative time, and stronger anticoagulant therapy for high-risk patients, such as those with past history of transient ischemic attack.
VL - 7
IS - 3
ER -

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Author Information

Hiroyuki Miura

Department of Thoracic Surgery, Akiru Municipal Medical Center, Akiruno City, Tokyo, Japan
Jun Miura

Department of Surgery, Kyorin University School of Medicine, Mitaka City, Tokyo, Japan
Hiroshi Hirano

Department of Pathology, Hachioji Medical Center of Tokyo Medical University, Hachioji City, Tokyo, Japan

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APA Style

Hiroyuki Miura, Jun Miura, Hiroshi Hirano. (2019). Cerebral Infarction After Lobectomy for Lung Cancer. Journal of Surgery, 7(3), 63-66. https://doi.org/10.11648/j.js.20190703.13

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ACS Style

Hiroyuki Miura; Jun Miura; Hiroshi Hirano. Cerebral Infarction After Lobectomy for Lung Cancer. J. Surg. 2019, 7(3), 63-66. doi: 10.11648/j.js.20190703.13

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AMA Style

Hiroyuki Miura, Jun Miura, Hiroshi Hirano. Cerebral Infarction After Lobectomy for Lung Cancer. J Surg. 2019;7(3):63-66. doi: 10.11648/j.js.20190703.13

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@article{10.11648/j.js.20190703.13,
  author = {Hiroyuki Miura and Jun Miura and Hiroshi Hirano},
  title = {Cerebral Infarction After Lobectomy for Lung Cancer},
  journal = {Journal of Surgery},
  volume = {7},
  number = {3},
  pages = {63-66},
  doi = {10.11648/j.js.20190703.13},
  url = {https://doi.org/10.11648/j.js.20190703.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20190703.13},
  abstract = {Background and objective: The left upper lobectomy as treatment for lung cancer has been identified as a risk factor for cerebral infarction. We analyzed cases of surgery for lung cancer to clarify factors that increase the risk for postoperative cerebral infarction. Methods: This study included patients with primary lung cancer who underwent lobectomy or segmentectomy with >ND1 lymph node dissection from 2008 to 2014 at Hachioji Medical Center of Tokyo Medical University. In total, 479 patients (294 males and 157 females) were examined. Cases of cerebral infarction occurring within 30 days of surgery were retrospectively studied. All surgeries were performed under mini-thoracotomy with thoracoscopy support. Vessels >7 mm in diameter were amputated using a linear stapler. Results: Cerebral infarction occurred in four male patients, representing 0.8% (4/479) of all lung cancers and 1.4% (4/294) of all male patients. Of these four patients, three were in their 60s (1.4% of 157 patients in their 60s) and one was in his 70s (0.5% of 215 patients in their 70s). Two cases involved adenocarcinomas, and two involved squamous cell carcinomas. One patient underwent right upper lobectomy, two underwent right lower lobectomy, and one underwent left upper lobectomy. The cerebral infarctions occurred in a branch of the vertebral artery. The pons was impaired in three cases, and the cerebellum was impaired in one. Three patients had pl2 disease, and one patient had pl3 disease. Operative time was 4–5 h in two cases, 5–6 h in one, and >6 h in one. Only pl factor significantly differed between patients with and without postoperative cerebral infarction. Conclusions: To prevent cerebral infarction, the following factors should be considered: preoperative smoking cessation, operative positioning to protect the vertebral artery, shortening of operative time, and stronger anticoagulant therapy for high-risk patients, such as those with past history of transient ischemic attack.},
 year = {2019}
}

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