Lung Cancer.pdf

Prevention and Management of Sequelae of Multimodality Therapy 253
Table 13–2. Indications for Pedicled Flap Coverage of a Bronchial Stump
or Bronchial Anastomosis
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Preoperative Therapy Delivered
Radiation Radiation
Procedure Therapy Therapy
Performed Chemotherapy 50 Gy 50 Gy Chemoradiation
Lobectomy Flap coverage Flap coverage Case Case
not indicated not indicated dependent* dependent*
Sleeve Flap coverage Flap coverage Flap coverage Flap coverage
lobectomy indicated indicated indicated indicated
Pneumo- Case Flap coverage Flap coverage Flap coverage
nectomy dependent indicated indicated indicated
when right when right
lung removed; lung removed;
flap coverage not indicated
not indicated when left lung
when left
lung removed
removed
* The decision whether to employ flap coverage requires examination of such factors as the lobe
resected, the patient’s overall health status, the presence of obstructive pneumonia, and the
proximity of the pulmonary artery to the bronchial stump.
these flaps retract owing to scarring. Details on harvesting of these flaps
and their applications are available in a variety of surgical textbooks.
Postoperative Management
The postoperative management of patients treated with multimodality
therapy is not significantly different from that of patients treated with
standard thoracic surgery alone. The application of aggressive pulmonary
toilet and a prompt and determined search for any infectious source is
critical. Postoperative anemia is more common in patients treated with
multimodality therapy. These patients frequently have some degree of
mild anemia or diminished bone marrow reserve before surgery. Hemoglobin
levels are evaluated on the first, third, and fifth postoperative days.
Significant anemia is treated with transfusions; milder anemia is treated
with the use of erythropoietin (e.g., Procrit). Iron supplementation is administered
carefully to avoid exacerbating the constipation often associated
with narcotics used in the postoperative period.
Electrolyte abnormalities after surgery are also more common in patients
treated with multimodality therapy. Subclinical renal toxicity from
neoadjuvant chemotherapy may become apparent in the postoperative
phase as a loss of electrolytes. Electrolyte levels are monitored during the