Thorac Cardiovasc Surg 2019; 67(04): 315-320
DOI: 10.1055/s-0038-1668600
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Unclassifiable Infectious Complications after Lobectomy for Cancer: Etiology, Risks, and Outcomes

Kazuhiro Ueda
1   Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
,
Junichi Murakami
1   Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
,
Toshiki Tanaka
1   Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
,
Kimikazu Hamano
1   Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
› Author Affiliations
Further Information

Publication History

21 February 2018

12 July 2018

Publication Date:
28 August 2018 (online)

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Abstract

Background Although infectious complications occur occasionally after lung lobectomy, some of them are overlooked if the pathogen or origin is unidentifiable.

Methods We retrospectively reviewed 425 patients who underwent lobectomy for lung cancer. Infectious complications developed in 61 patients who consequently underwent empiric therapy: 44 had an identifiable focus and 17 did not irrespective of systemic surveillance.

Results The 17 patients without an identifiable focus were predominantly patients with squamous cell carcinoma, a smoking history, large tumor size, and undergoing lower lobectomy. These 17 patients were able to be distinguished from those without infectious complications with a sensitivity of 88% and a specificity of 98% based on the patient's body temperature, C-reactive protein, and white blood cell count. The median onset of the 17 patients was 8 days (5–30 days) after operation. None of these 17 patients had air leak for more than 3 days, major cardiopulmonary complications, superficial surgical site infection, organ-specific symptoms (e.g., cough and diarrhea), or increased dead space size. Inflammatory markers were normalized by antibiotics alone in 14 of the 17 patients, while the condition of the remaining 3 worsened to empyema that required some intervention. One patient eventually died after thoracoscopic debridement.

Conclusion Postoperative acute onset of infectious complication without any specific symptoms or any identifiable focus should be included in a separate category of complications. We must clarify the pathology of this complication (e.g., occult bronchopleural fistula), but for now, careful management is mandatory, as therapeutic failure can lead to a fatal outcome.