Risk factor analysis of cerebral infarction and clinicopathological characteristics of left upper pulmonary vein stump thrombus after lobectomy.

OBJECTIVE: We aimed to analyze the risk factors of postoperative cerebral infarction (CI) and thrombus formation in the left upper pulmonary vein (PV) stump after lobectomy.

METHODS: We retrospectively investigated 1670 patients who underwent lobectomy or more intervention, and analyzed the risk factors of postoperative CI. Furthermore, postoperative contrast-enhanced computed tomography (CE-CT) were reviewed in patients who underwent left upper lobectomy (LUL), and risk factors of the thrombus formation in the left upper PV stump were evaluated. Chi-square test or unpaired t test was used to compare the factors.

RESULTS: Cerebral infarction was observed in 10 (0.60%) patients, being more significant in patients with left side lesions (90%) who underwent LUL (50%). Eighty percent of the CI cases occurred by day 4 postoperative. CI was found in 1.47% after LUL. Among 339 patients who underwent LUL, CE-CT was performed in 137 (40%) postoperatively. Among them, left upper PV stump thrombus was found in 16 (11.7%), which was statistically significant in higher age and p stage II or more disease (= 0.003, 0.040). In contrast, preoperative histories including anticoagulant administration, atrial fibrillation, diabetes mellitus, several surgical procedures or intraoperative factors were not associated statistically with thrombus formation.

CONCLUSION: Postoperative CI occurred in the very early-phase after lobectomy, and the incidence was significantly higher in patients undergoing LUL. Because left upper PV stump thrombus was frequently found retrospectively, a prospective observation study would be required to investigate the real incidence of PV stump thrombus after lobectomy.