Wittengland5097

Depending on the situations, preservation of the bronchial artery, thoracic duct, and azygos arch should be considered. A care bundle by a multidisciplinary perioperative management team may decrease postoperative morbidity and mortality rates in elderly patients undergoing esophagectomy.The number of patients receiving hemodialysis has increased, and a proportionate increase of such patients with malignant tumor is expected. NF-κB inhibitor Hemodialysis patients are associated with a special condition, which is an obstacle during surgery. Surgery for dialysis patients is associated with high risk due to heart failure, respiratory failure, bleeding tendency, and immunosuppression. Therefore, dialysis patients should undergo sufficient preoperative evaluation and course of dialysis before surgery. In addition, minimally invasive surgery are required to reduce a risk of postoperative complication, and recently video-assisted thoracic surgery is performed. To reduce bleeding, using nafamostat mesilate on hemodialysis is also important management method. Careful infusion is necessary because volume overload causes the most dangerous complications, heart failure and pulmonary edema. Because dialysis patients are easily infected, sufficient care must be taken for wound infection, pneumonia, and empyema. Dialysis patients require careful perioperative management, but standard surgery is possible. However, prognosis for lung cancer with hemodialysis patient is not satisfactory. Future research on postoperative therapy including anticancer drugs is expected.By improvement of surgical procedures and advances in perioperative management, the patients with various comorbidity diseases have been able to undergo pulmonary resection. In particular, the patients with endocrine and metabolic disorders are relatively frequent and often underwent pulmonary resection. Most of them are chronic diseases and often controlled for a long time. However, they sometimes have drastic changes due to surgical stress during perioperative periods. Failure to properly perioperative management for them may result in postoperative morbidity or mortality. Therefore, we have to well know perioperative changes by surgical stress for them. Among endocrine and metabolic disorders, following is frequent, diabetes, hyperthyroidism and hypothyroidism, steroid administration. We describe perioperative management of them. When operating on them, it is important to ① proper evaluation before surgery, ② careful postoperative management, and ③ close coordination with the department of endocrinology and anesthesiology.Recent changes in the demographics of surgical candidates, in terms of age, have increased the number of patients with surgical risk factors. In patients with preoperative cardiac diseases such as myocardial ischemia, arrhythmia, or congestive heart failure, it is important to offer any necessary preoperative medical examinations and treatments because postoperative cardiac failure is more of a concern in patients with already abnormal cardiac physiology, undergoing significant lung resection. Thoracic surgeons should be challenged by another conundrum to accurately select the best candidates for surgical treatment. Usually perioperative management of antithrombotic therapy in patients who need general thoracic operations such as lung cancer surgery after coronary artery stent placement or valve replacement have made recommendations, and heparinization is needed for patients with atrial fibrillation for prevention of thrombo-embolism. It is sometimes used in clinical practice as bridging therapy during the period of discontinuation of antiplatelet therapy for patients with cardiac complications after several cardiac surgery. As points to be aware of regarding surgical operations, minimal invasive surgery probably should be performed if possible.The Japanese Joint Committee of Lung Cancer Registry reported that 1,091 patients( 5.8%) had cerebrovascular diseases as comorbidities in "A report from the Japanese Joint Committee of Lung Cancer Registry;a study of 18,973 surgical cases in 2010;secondary publication". They reported that 24 patients caused cerebral hemorrhage or cerebral infarction within 30 days after surgery. Since the elderly patient surgery is increasing, the incidence their perioperative stroke is increasing too, often leading to severe conditions. It is necessary to evaluate the risk factors and history of cerebrovascular disease prior to surgery. As most perioperative strokes occur within 3 days after surgery, and the recurrence rate is higher in patients with a history of cerebrovascular diseases, systematic perioperative management should be treated to prevent recurrence in the perioperative period. If patient taking antithrombotic drugs undergo surgery, it is necessary to be informed of the risks such as intraoperative stroke associated with pausing and resuming antithrombotic drugs. Patient with cerebrovascular disease must be diagnosed accurately and promptly, as cerebrovascular disease involves the conditions of ischemia and hemorrhage.Pulmonary dysfunction with lung cancer has been shown a major postoperative risk factor in patients undergoing thoracic surgery. Preoperative physiological assessment according to guideline by American College of Chest Physicians (ACCP) or European Respiratory Society( ERS)/European Society of Thoracic Surgeons (ESTS) is important to select patients due to evaluate the risk of lung resection for a lung cancer patient. Moreover, for lung cancer patients undergoing thoracic surgery with pulmonary dysfunction, circulatory function evaluation is important in addition to preoperative respiratory management and rehabilitation. Thoracic surgery for patients with pulmonary dyfunction should be selected to assess preoperative pulmonary function and to predict postoperative complications.Interstitial lung diseases (ILDs) are associated with an increased risk of lung cancer, and pulmonary resection is well known to be associated with high postoperative morbidity and mortality in lung cancer patients. Postoperative mortality rate of acute exacerbation( AE) was reported 33.3~100%. Sex, CRP, KL-6, %vital capacity( VC), forced expiratory volume in 1 second( FEV1.0), history of AE, preoperative steroid use, and surgical procedures were identified as possible risk factors of AE in the univariate analyses by the data obtained from patients with non-small cell lung cancer who had undergone pulmonary resection and presented with a clinical diagnosis of ILD between January 2000 and December 2009 at 64 institutions throughout Japan. Multivariate analysis using these factors identified surgical procedures except for wedge resection, history of AE, KL-6, %VC, and male sex as independent risk factors. A score by risk prediction for AE was 5 X (history of AE)+4 X (CTUIP pattern)+3 X (gendermale)+3 X (preoperative steroid use)+2 X (KL-6>1,000 U/ml)+1 X (VC≤80%).