Coronavirus Disease 2019 in the Perioperative Period of Lung Resection: A Brief Report From a Single Thoracic Surgery Department in Wuhan, People's Republic of China

Abstract

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, People's Republic of China, and has subsequently spread worldwide. Clinical information on patients who contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the perioperative period is limited. Here, we report seven cases with confirmed SARS-CoV-2 infection in the perioperative period of lung resection. Retrospective analysis suggested that one patient had been infected with the SARS-CoV-2 infection before the surgery and the other six patients contracted the infection after the lung resection. Fever, lymphopenia, and ground-glass opacities revealed on computed tomography are the most common clinical manifestations of the patients who contracted COVID-19 after the lung resection. Pathologic studies of the specimens of these seven patients were performed. Pathologic examination of patient 1, who was infected with the SARS-CoV-2 infection before the surgery, revealed that apart from the tumor, there was a wide range of interstitial inflammation with plasma cell and macrophage infiltration. High density of macrophages and foam cells in the alveolar cavities, but no obvious proliferation of pneumocyte, was found. Three of seven patients died from COVID-19 pneumonia, suggesting lung resection surgery might be a risk factor for death in patients with COVID-19 in the perioperative period.

Keywords: 2019 Novel coronavirus disease; Characteristics; Lung resection; Perioperative period; Severe acute respiratory syndrome coronavirus 2.

Figure 1

Representative chest CT images in seven patients with COVID-19. (A) A 63-year-old man who underwent VATS right lower lobe lobectomy and lymphadenectomy. CT scans performed 14 days before the surgery revealed bilateral infiltrative opacification in the periphery of the lung and a subpleural ground-glass attenuation in the right lower lobe (arrow). CT images on postoperative day 4 revealed bilateral multifocal GGOs with consolidation. (B) A 57-year-old man who underwent left lower lobe and segment 4 plus 5 sleeve resection through open surgery. CT scans revealed ground-glass shadowing in the right lung and gradual absorption of infiltration in the left upper lobe from postoperative day 7 to day 20. (C) A 68-year-old man who underwent right lower lobe lobectomy with reconstruction of the right bronchus intermedius and lymphadenectomy. CT images on postoperative days 31 and 38 revealed a mixture appearance of GGOs with superimposed reticulation at bilateral lungs. (D) A 57-year-old man who underwent VATS right upper lobe lobectomy and lymphadenectomy. CT images revealed subsegmental consolidation in the right middle lobe and right encapsulated pleural effusion on postoperative day 11, which gradually resolved on postoperative day 18, and a progression of the ground-glass shadowing in the left lung was presented. (E) A 61-year-old man who underwent VATS left upper lobectomy and lymphadenectomy. CT images revealed pneumothorax and atelectasis on postoperative day 6 that resolved on day 10. CT images on postoperative day 10 revealed presence of GGOs with superimposed reticulation in the periphery of the right lung. (F) A 60-year-old woman who underwent VATS wedge resection of left upper lobe with basal segmentectomy and lymphadenectomy. CT images revealed persistent GGOs in the right middle and lower lobe on postoperative days 10 and 19. (G) A 56-year-old woman who underwent VATS right lower lobe lobectomy. CT images revealed bilateral multifocal GGOs and pleural effusion on postoperative day 16. COVID-19, coronavirus disease 2019; CT, computed tomography; GGO, ground-glass opacity; VATS, video-assisted thoracic surgery.

Figure 2

Histopathologic examination of lung tissue distant from the tumor. (A) Diffuse lung interstitial inflammation with inflammatory cell infiltration (patient 1, original magnification ×40). (B) Thickened alveolar septum and fibrous connective tissue proliferation accompanied with plasma cell and macrophage infiltrates. Macrophages and foam cells infiltrate the alveolar cavities (patient 1, original magnification ×200). (C–H) Pulmonary histology without inflammation findings (original magnification ×100).