Incidence and clinical features of the incidentally found vascular stump thrombus during routine follow up after oncologic lung surgery

• Published in: PloS one Vol. 12; no. 9; p. e0185140
• Main Authors: Moon, Mi Hyoung, Beck, Kyongmin Sarah, Moon, Young Kyu, Park, Jae Kil, Sung, Sook Whan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.09.2017; Public Library of Science (PLoS)
• Subjects: Adenocarcinoma; Aged; Anticoagulants; Biology and Life Sciences; Blood clots; Cardiovascular disease; Care and treatment; Cohort Studies; Complications and side effects; Computed tomography; Demographics; Demography; Drugs; Embolisms; Female; Follow-Up Studies; Hazard assessment; Heart surgery; Hospitals; Humans; Incidence; Incidental Findings; Lung cancer; Lung diseases; Lung Neoplasms - blood supply; Lung Neoplasms - surgery; Lung surgery; Male; Medical imaging; Medical records; Medicine and Health Sciences; Middle Aged; Patient outcomes; Patients; Pulmonary arteries; Regression analysis; Research and Analysis Methods; Retrospective Studies; Risk analysis; Risk Factors; Surgery; Therapy; Thoracic surgery; Thromboembolism; Thrombosis; Thrombosis - complications; Thrombosis - diagnosis; Thrombosis - diagnostic imaging; Tomography; Tomography, X-Ray Computed; Veins & arteries; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0185140

We aimed to evaluate the incidence and clinical features of vascular stump thrombus after oncologic lung surgery. A retrospective analysis of records from our institutional database dated between 2009 and 2016 was performed. Data regarding demographics, clinical presentation, medication use, operative findings, pathology, and radiologic findings were retrieved. The study cohort consisted of 648 oncologic surgeries for primary lung cancer. The incidence of thrombus in the entire population was 5.7% (37/648). Most thrombi were incidentally found on follow-up chest computed tomography scans. Univariate Cox proportional hazard analysis showed that age (p = 0.02), adjuvant therapy (p <0.001), neoadjuvant therapy (p = 0.04), left-sided surgery (p = 0.02), complex surgery greater than simple lobectomy or segmentectomy (p <0.001), advanced stages (p <0.001), non-adenocarcinoma (p = 0.003), and thoracotomy approach (p = 0.009) were associated with an increased risk of vascular stump thrombus. There were no embolic events in our cohort, except for a case of pulmonary thromboembolism. During follow-up, 43.2% (16/37) of thrombi had completely resolved, 48.6% (18/37) showed partial regression and stabilization, and 8.1% (3/37) had progressed. The incidence of vascular stump thrombus in our study was not negligible. The clinical course of stump thrombus appears to be benign in most cases. Anticoagulation may be used with caution based on an individual basis depending on each patient's risk factors.