Frequency and predictors of pulmonary arterial stump thrombosis following pneumonectomy or lobectomy

OBJECTİVE: Pulmonary artery stump thrombi is detected in some cases following pneumonectomy/lobectomy. In the literature, there are no data except case studies and only limited studies in cases with lung carsinoma. In this study, we aimed to investigate the frequency of thrombi in the pulmonary artery stump and the risk factors leading to thrombi in patients who were operated for lung carcinoma or for other reasons in our hospital. The secondary purpose was to evaluate the clinical significance and resolution of thrombi. METHODS: The study was conducted retrospectively between January 2014 and December 2018 in the Farabi Hospial of Karadeniz Technical University. Adult patients who underwent pneumonectomy or lobectomy for any reason and underwent postoperative control thorax tomography were included in the study. Demographic characteristics of the patients, clinical information (smoking history, comorbid diseases, familial cancer history, risk factors that predispose to thrombi), operative information (cause of surgery, operation date, pulmonary artery ligation technique, pathology result, stage of malignancy, surgical procedure), information related to the thrombi (first detection date, anticoagulant treatment etc.), length of pulmonary artery stump and the patient's final admission dates to the hospital were recorded. RESULTS: The total number of pneumonectomy and lobectomy performed during the 4-year period was 454 (93 pneumonectomy, 361 lobectomy). Of these, 350 were operated for primary lung cancer and 104 for non-primary lung cancer. (4.5%) of the 202 patients included in the study had pulmonary artery stump thrombi [2.6% (4/152) in patients who underwent lobectomy and 10% (5/50) in patients who underwent pneumonectomy (p: 0.043)]. Stump thrombus was detected in 9 of 185 (4.8%) patients who were operated for malignancy, whereas stump thrombus was not seen in 17 patients who were operated for reasons other than lung cancer (p: 1.00). In patient whose pulmonary artery have been ligating by stapler, more thrombus was detected in the stump (p:0.034). Stump length was found to be 23 mm (min: 9, max: 40) in patients with thrombi and 8 mm (min: 0, max: 68) in patients without thrombi (p<0.001). There were no change in thrombi in 4 patients, complete regression in 3 patients and partial regression in 1 patient. One patient died without control tomography. CONCLUSIONS: In conclusion, our study showed that pulmonary artery stump thrombus developed in 4.5% of patients who underwent lobectomy / pneumonectomy for any reason and especially thrombi was more frequent in patients whoes underwent pneumonectomy, whoes pulmonary artery have been ligating by stapler and whoes had longer pulmonary artery stump.