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Publications

Journal Article Ppublish

PubMed: 42423783 DOI: 10.1007/s00595-026-03400-2

Incidence and outcomes of pulmonary artery injury during anatomical lung resection for lung cancer: a nationwide database study in Japan.

Surg Today 56(11):2632-2642

Authors: Hideo Ichimura, Hiroyuki Yamamoto, Yukio Sato, Masayuki Chida, Ichiro Yoshino, Yoshinori Okada, Masayoshi Inoue, Yasushi Hoshikawa, Hiroyuki Ito, Hidetaka Uramoto, Yasushi Shintani, Toshihiko Sato, Toyofumi Fengshi Chen-Yoshikawa, Keisuke Asakura, Mariko Fukui, Masafumi Kawamura, Yukinori Sakao, Shinichi Toyooka

Affiliations

  • Department of Thoracic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan.
  • Department of Healthcare Quality Assessment, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. Department of Health Data Science, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
  • Department of Thoracic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Ibaraki, Japan.
  • Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
  • Department of Thoracic Surgery, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan.
  • Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan.
  • Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
  • Department of Thoracic Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
  • Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
  • Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan.
  • Department of General Thoracic Surgery, The University of Osaka, Suita, Japan.
  • Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University, Fukuoka, Fukuoka, Japan.
  • Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
  • Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
  • Department of General Thoracic Surgery, Juntendo University, Bunkyo- ku, Tokyo, Japan.
  • School of Medicine, Teikyo University, Itabashi-ku, Tokyo, Japan.
  • Department of Surgery, Teikyo University School of Medicine, Itabashi- ku, Tokyo, Japan.
  • Department of General Thoracic Surgery and Brest and Endocrinological Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Okayama, Japan.

Abstract

PURPOSE

To evaluate the incidence, characteristics, and perioperative outcomes of pulmonary artery (PA) injury during lung cancer surgery using data from the Japanese National Clinical Database (NCD).

METHODS

We analyzed patients who underwent lobectomy or segmentectomy for clinical stage I-III primary lung cancer registered in the NCD between 2018 and 2021. The clinicopathological features and perioperative outcomes were compared between patients with and without PA injury. Subgroup analyses were performed according to blood loss categories and the causes of mortality.

RESULTS

PA injury occurred in 1,325 of 142,343 patients (0.9%). It was more frequent in older patients, those with a higher BMI, advanced-stage disease, and left upper lobe resections. PA injury was associated with longer operative duration, greater blood loss, and higher transfusion rates. Postoperative complications were more frequent in the PA injury group. Thirty-day mortality (1.2% vs. 0.4%) and operative mortality (1.5% vs. 0.6%) rates were higher. Mortality was notably higher when intraoperative blood loss exceeded 2000 mL, regardless of PA injury. A female sex, obesity, and cN0 status were more common among patients with PA injury-related mortality.

CONCLUSIONS

Intraoperative PA injury occurred in nearly 1% of resections and it was associated with poor outcomes. A hemorrhage exceeding 2000 mL may therefore be a critical mortality marker.

MeSH

Mortality, Lung, Blood, Incidence, Neoplasms, Pulmonary Artery, Arteries, Lung Neoplasms, General Surgery