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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Mizobuchi T. 1, 2, Nakajima T. 2, Shibuya K. 2, Iyoda A. 2, Suzuki M. 2, Sekine Y. 2, Fujisawa T. 2
1 Department of Chest Surgery Matsudo Municipal Hospital Chiba, Japan
2 Department of Thoracic Surgery Graduate School of Medicine Chiba University, Chiba, Japan
Aim. Recent advances in hemodialysis (HD) in patients with renal insufficiency have improved long-term survival. The purpose of this study was to evaluate peri-operative strategies in HD patients who undergo thoracotomy for primary lung cancer.
Methods. We screened 1582 patients who underwent pulmonary resection for primary lung cancer from January 1990 to March 2006. We identified 9 patients on maintained HD who underwent thoracotomy.
Results. The patient population consisted of 6 men and 3 women, with a mean age of 63.2(48-74) years. The mean levels of blood urea nitrogen, serum creatinine, and serum potassium after HD were 16.4(4-27) mg/dl, 3.1(1.7-6.3) mg/dl, and 3.3(3.1-3.6) mEq/l, respectively. Histological diagnoses were 5 adenocarcinomas (Ad), 2 squamous cell carcinomas (Sq), 1 adeno-squamous cell carcinoma (Ad-Sq), and 1 double cancer consisting of Ad and Sq. Lobectomy with lymph node dissection was performed in 8 patients, including bronchoplasty in 2. Right S1 wedge resection was selected in one. Post-operative HD was initiated in the first 2 days after surgery. In the 3 most recent cases, HD was restarted on the day after the operation and maintained three times per week. Post-operative hyperkalemia occurred in three patients and was successfully controlled by glucose-insulin therapy and continuous hemodiafiltration (CHDF) with nafamostat mesilate. There was no operative mortality.
Conclusion. We conclude that surgical treatment for lung cancer is feasible in patients on HD using careful peri-operative management. CHDF enables us to treat hyperkalemia safely even when the circulation is unstable and there is post-operative bleeding.