Postlobectomy Early Complications

Abstract

Immediate postoperative complications are common after lobectomy. The most effective management of postoperative crises is prevention, which starts with preoperative preparation and patient screening. There are many factors that can be controlled and improved by the patient. Equally important is patient selection, which is influenced by pulmonary function tests, cardiopulmonary reserve, and preexisting comorbidities. After the operation, the care team can also greatly improve outcomes with aggressive cardiopulmonary therapies, ambulation, vigilant monitoring, and frequent assessments of the patient. Prevention strategies can minimize risks; however, when they occur, a proactive approach may minimize the long-term sequelae.

Keywords: Air leak; Atrial fibrillation; Chylothorax; Hemorrhage; Nerve injury; Pneumonia/mucous plugging; Right middle lobe torsion.

Figure 1

Butressed Stapler

Figure 2

Immediate Postoperative Chest X-Ray

Figure 3. Postoperative Mucous Plugging Chest X-Ray

Arrows denote mediastinal shift to the side of the collapse

Figure 4

Post-bronchoscopy Chest X-Ray

Figure 5. Management of post-operative atrial Fibrillation

[35] ASA: acetylsalicylic acid [aspirin]; COPD: chronic obstructive pulmonary disease; ILD: interstitial lung disease; INR: international normalized ratio

Figure 6

Immediate Post-operative Chest X-Ray

Figure 7. Post-operative Day 1

(arrow indicates RML opacification)

Figure 8. Management Algorithm for Chylothorax

TG=triglyceride, NPO=nothing per os, TPN=total parenteral nutrition, s/p=status post [47] Ziarnik E, Nesbitt J.