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Thromboembolic Disease: Diagnosis, Risk Groups, and Treatment


Wednesday, October 27, 2004

12:30 PM- 2:00 PM

Incidence Of Postoperative Pulmonary Embolism (PE) Detected By Multi-slice Computerized Tomography(MSCT)In Lung Surgery For Cancer

Mark Ragusa, MD*, Giuliano Daddi, MD, Giulia Milillo, MD, Luciano Lupattelli, MD, Angelo Lemmi, MD, Francesco Puma, MD, Filippo Calzolari, MD and Giancarlo Agnelli, MD

Division of Thoracic Surgery, University of Perugia, Perugia, Italy

PURPOSE: The incidence of pulmonary embolism (PE) in patients undergoing lung surgery for cancer remains undefined. In these patients the risk for venous thromboembolism is potentially high due to the combination of prothrombotic effects of cancer, extensive surgery, prolonged immobilization and parietal and endothelial local alteration consequent to surgery. The aim of this study was to assess the incidence of PE after lung surgery for cancer using MSCT scan.

METHODS: PE was detected by MSCT (GE Light-Speed 4x1,25) scan performed 7-15 days after surgery. Diagnostic criteria for PE were complete or partial intraluminal filling defect. Patients were scheduled to receive pharmacological prophylaxis for venous thromboembolism with low-molecular-weight heparin (LMWH) starting the first post-operative day, until discharge.

RESULTS: Fifty patients were included in this study. The average age was 66,5 (range 26 to 90). Diagnosis of cancer was confirmed in all except one patient found to be affected by tuberculosis. Thirty-six patients underwent lobectomy, 11 pneumonectomy, and the remaining 3 patients wedge resection. Histology showed epidermoid carcinoma in 20 cases, adenocarcinoma in 15, anaplastic carcinoma in 7, and other types in the remaining 8 cases. All patients but two received prophylaxis for venous thromboembolism. Seven patients (14%) showed PE at MSCT scan. Of the PE, 5 involved central arteries (principal, lobar and segmentary) and 2 subsegmentary arteries. Two of the patients with MSCT scan detected PE were symptomatic.

CONCLUSION: PE is a common complication in patients undergoing lung surgery for cancer, despite antithrombotic prophylaxis.

CLINICAL IMPLICATIONS: In such high-risk population prophylactic regimens should be optimized.

DISCLOSURE: M. Ragusa, None.






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