The Outcome of Lung Cancer Surgery in Patients on Chronic Hemodialysis: A Multicenter Study

The Outcome of Lung Cancer Surgery in Patients on Chronic Hemodialysis: A Multicenter Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Outcome of Lung Cancer Surgery in Patients on Chronic Hemodialysis: A Multicenter Study Elena Carrese, Cristian Rapicetta, Alessandro Stefani, Tommaso Ricchetti, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6680380/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The end-stage renal disease is arising worldwide, but there are few reports about pulmonary resection in hemodialysis patients with lung cancer. The objective of the authors is to assess lung cancer surgery outcomes in patients undergoing hemodialisys, to identify the risk factors for morbidity, mortality and overall survival. Methods Clinical records data of 19 hemodialysis patients undergoing curative surgery for lung cancer in 3 centers between 2001 and 2021 were retrospectively collected and analyzed. There were considered pre-operative and perioperative variables and their relationship with morbidity, mortality and survival. Results The complication rate was 84%, with a mortality rate of 5%. The most common complication was bleeding. Heavier smoking history was associated to higher risk of developing complications. Also transfusions were associated with complications. The 5-years overall survival (OS) rate was 29%, while the 5-years Disease free survival (DFS) rate was 62%. OS was correlated with age and clinical stage. Most patients showed non cancer-related deaths. Conclusions In conclusion, although the mortality is remarkable in patients in hemodialisys, the data about OS and DFS make us believe that lung surgery may be still a therapeutic option if patients are properly selected and careful perioperative management is performed. Biological sciences/Cancer Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Nephrology Health sciences/Oncology Health sciences/Risk factors Health sciences/Signs and symptoms hemodialysis lung cancer end-stage renal disease pulmonary resection Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background The number of end-stage renal disease patients on hemodialysis is on the rise worldwide. The prognosis of these patients has improved due to advances in dialysis techniques leading to decrease in incidence of death for cardiovascular disease. Conversely the incidence of infection and malignant disease is increasing instead. The relative risk of lung cancer, unlike other types of cancer, does not seem to be higher than normal population, but as the prevalence of patient on hemodialysis increases, the number of surgery resections for lung cancer is expected to increase. The management of systemic therapy for lung cancer is very complex in patient receveing hemodialysis and there is little data avaible about target therapy and immunotherapy. Patients on dialysis represent a high risk group beacause of cardiovascular disease, diabete mellitus, electrolyte imbalance, hemodynamic instability, metabolic disorder, anemia, bleeding tendency, immunosoppression. These problems can lead to post-operative complication, requiring careful peri-operative management. However, there are only few reports about pulmonary resection in hemodialysis patients with lung cancer. Methods This study was approved by Ethics Committee of Azienda USL-IRCCS of Reggio Emilia (207/2021/OSS/IRCCSRE on 27/4/2021). Consent to Participate declarations: not applicable according to national regulations (GDPR n. 679/2016, del D. Lgs. 196/2003, come modificato dal D. Lgs. 101/2018 e dal Provvedimento del Garante per la protezione dei dati personali n. 146 del 05/06/2019). The authors declare that all methods were performed in accordance with ethical guidelines. This is a multicenter retrospective observational study who involves hemodialysis patients undergoing pulmonary resection for lung cancer in the last 20 years (2000–2021) in 3 different Thoracic Surgery Centers. Patients undergoing peritoneal dialysis and who have started dialysis in perioperative period were excluded. The variables collected were: Preoperative: sex, age, smoking habit, performance status, body mass index, FEV1 (Forced Expiratory Volume in 1 second), DLCO (diffusing capacity of the lungs for carbon monoxide), PaO2, PaCO2, cardiac Ejection Fraction (EF), Charlson Comorbidity Index (CCI), taking antiplatelet/anticoagulant drugs, type of nephropaty, duration of hemodialysis, serum urea, creatinine, potassium, hematocrit, hemoglobin, total proteins (the values are referred to the day before the operation), time elapsed between the last hemodilysis session and the operation. Intraoperative: type of surgical access (Thoracoscopy ot thoracotomy), type of intervention, type of limphadenectomy, duration of the intervention, intraoperative bleeding. Postoperative: serum potassium value, time interval between operation and the first hemodialysis session, need for urgent dialysis sessions, postoprative complications (typology of complications and severity according to Clavien-Dindo classification), need for blood transfusions, admission to intensive care, duration of drainage, length of post-operative hospital stay. Related to the neoplasm: clinical stage, pathological stage, hystotype. Follow-up: patient status (alive/dead), presence of recurrence, site of recurrence, cause of death, overall survival and cancer related survival and disease free survival at 1,2,3,4,5. Times: dialysis start date, date of surgery, date of last observation, recurrence date, death date. Classifications used are: ECOG (Eastern Cooperative Oncology Group) Performance status; Charlson Comorbity Index; Clavien-Dindo Classification of complications. Performance statuts is an evalution of patient’s general conditions and daily life skills. ECOG scale, published by Oken et al. nel 1982 [ 1 ], allows to assign a score from 0 to 5, where 0 indicates perfect health while 5 indicats death. Charlson Comorbity Index (CCI) is used to classify comorbidities that affect mortality risk [ 2 ]. 19 medical conditios are considered (16 diseases, 3 of which are stratified according to gravity); each is given a score from 1 to 6, with final score from 0 to 33. Score is adjusted with age, getting a combined age comorbity index from 0 to 37. Clavien-Dindo Classification is a complication subdivision system [ 3 ]. Statistical analysis Descriptive Statistics: categorical variables were expressed as frequencies and percentages. Continuous variables were expressed by mean +/- standard deviation or median and interquartil range. Analytical Statics: preoperative and intraoperative variables were analysed with complications to identify possible associations. Comparison between categorical variables was performed with Chi square test (Fischer exact-test correction was used for small samples as indicated); continuous variables were compared with Student’s T-Test or ANOVA. The variables arranged in ranks were compared with non-parametric tests (Mann-Whitney or Kruskal-Wallis). As cut-off for the categorization of continuous variables in 2 subgroups median value of variable was used. Survival was considered from intervention to last observation date (OS) or. from intervention to recurrence date (DFS), if present. The OS and DFS were computed by the Kaplan-Meier method, and differences between groups calculated using the Log-Rank test. Some statistical tests, given the small sample size, had not been carried out because of low reliability. All statistical analyses were performed using SPSS 26.0 (SPSS inc., Chicago, IL). Results Characteristics of the patients Patients's characteristics are shown in the Table 1 . The study includes 19 patients, mostly men (15/17, 79%), with an average age of 71 years. All subjects were smokers or former smokers. Nephroangiosclerosis and Glomerulonephritis were the main causes of end-stage renal failure (37% and 32% respectively). The average duration of dialysis was 27 months. The last dialysis for surgery was performed the day before surgery in all but 2 patients. Regarding respiratory function, the values of FEV1% were <80% in 3 patients (16%), PaO₂<80 mmHg in 3 cases (16%). All patients had an echocardiogram with cardiac ejection fraction values <50% in 4 cases (21%). Regarding biohumoral tests, urea and creatinine were obviously high on average, while potassium value and serum proteins were well controlled. Most patients presented preoperative anemia (68%). Eleven patients (58%) were taking antiplatelets drugs (8/10), including acetylsalicylic acid, clopidogrel and ticlopidine, or warfarin and enoxaparin as anticoagulants (2/10). For one patient it is unknown whether he took antiplatelets or anticoagulants. Charlson Comorbidity Index has a maximum of 37 points, but in this study the maximum score was 13. Most patients had a score between 6-10. Most common comorbidities were arterial hypertension (13 cases), chronic peripheral vascular disease, chronic ischemic heart disease, presence of other malignant neoplasm and COPD (Chronic Obstructuve Pulmonary Disease) ( Table 2 ). Table 2 Comorbidities N (%) Arterial Hypertension 13 (68) Chronic Vascuolopathy 6 (31) Chronic ischemic heart disease 6 (31) Neoplasm 5 (26) COPD 4 (21) Epatopathy HCV-related 2 (10,5) Insulin-dependent Diabetes 2 (10,5) Atrial Fibrillation 2 (10,5) Stroke oucomes 1 (5,2) Chronic Respiratory Failure 1 (5,2) Cardiac valvulopathy 1 (5,2) Epilepsy 1 (5,2) Comorbidities Perioperative Variables The Tables 3 and 4 summarize variables related surgery and postoperative period. In 16 patients surgical access was thoracotomy, while only 3 patients underwent videothoracoscopy, lobectomy was performed in most patients (68%) and in all cases the intervention was radical. Table 3 Variables N Type of intervention - Lobectomy - Wedge resection 13 (68%) 6 (32%) Type of linfoadenectomy - Sampling - Radical - None 14 (74%) 2 (10%) 3 (16%) Duration of intervention (min) - Average - Range 144 (67-260) Intraoperative blood loss (mL) - Average - Range 266 (0-2000) Intraoperative Variables The results about complications were: sixteen patients (84%) presented postoperative complications (included hyperkalemia), ranked according Clavien-Dindo Classification. The Table 4 shows the list of complications. 10 patients presented only one complication, 3 patients 2 complications and 3 patients 3 complications. Table 4 Complication N (%) Hemorrhage 5 (26) Hyperkalemia 4 (21) Pneumonia/lung abscess 3 (16) Respiratory failure 3 (16) Prolonged air loss 2 (10,5) Acute Respiratory Distress Syndrome (ARDS) 1 (5) Atelecyasis/Bronchial obstruction 1 (5) Heart Failure 1 (5) Acute Myocardial Infarction 1 (5) Pulmonary Edema 1 (5) Intestinal Perforation 1 (5) List of postoperative complications Transfusion was necessary in 9 patients for hemoglobin value <8 g/dL and admission in Intensive care in 9 patients (7 patients of which for respiratory or multiple organs failure). Emergency dialysis was performed in 6 patients, in 5 for hyperkalemia and in 1 case for acute pulmonary edema. In the last cases the first postoperative dialysis was performed in 10 cases on the first post-operative day and in 5 cases two days after surgery. 30-day mortality was 5%, because one patient died after 27 days. If we consider in-hospital mortality, the percentage rises to 10,5%, because one patient died 37 days after surgery. The cause of death was multiple organ failure in both cases. They both had a CCI of 9 and had undergone lobectomy and wedge resection repectively. The table 5 shows Post-operative Variables Table 5 Variables N Postop Potassium (mmol/L) - Average - Range 4,2 3,2-8,4 Emergency dialysis - Yes - No 6 (32%) 13 (68%) Postoperative complications - Yes - No 16 (84%) 3 (16%) Clavien – Dindo Classifications - I - II - III - IV - V 4 (21%) 5 (26%) 2 (10,5%) 6 (32%) 2 (10,5%) Blood transfusion - Yes - No 9 (47%) 10 (53%) Intensive care admission - Yes - No 9 (47%) 10 (53%) Duration of drainage (days) - Average - Range 8 2-69 Post-operative hospital stay (days) Average Range 17 (6-54) Post-operative Variables Variables related to tumor and survival Table 6 Histological type N (%) Adenocarcinoma 12 (63) Squamous cell carcinoma 6 (32) Other 1 (5) Variables related to hystological type Histologically, the most common tumor was adenocarcinoma ( Table 6 ), according to the increased incidence in the whole population. Most of patients were in stage I (15/19, 79%), as represented in the Table 7 . Table 7 Stage N (%) Ia 10 (53) Ib 5 (26) IIa 0 (0) IIb 2 (11) IIIa 2 (11) Stage-related Variables The average follow-up was 34 months. At the end of follow up 14 patients died (74%), including the 2 post-operative deaths. Only 1 patient died of cancer (5%), while 13 patients died of other causes. 4 patients relapsed (21%), 3 loco-regional recurrences and 1 cerebral recurrence. 2 of these patients died after 29 and 38 months, one patient died 11 months later, while one patient was alive after 63 months, with a recurrence within 8 months. Median overall survival was 4 months. The OS and DFS are showed in Figure 1 and 2 . Regarding the preoperative and perioperative factors affecting the development of complications, the only statistically significant association involved the smoking habit. Patients with an important story of cigarette use had a higher incidence of complications ( Table 8 ). Table 8 complications N Average Std. Deviation P value pack/years no 6 19,50 6,595 0,033 si 12 39,00 19,684 Significant correlation between smoke and complications (T-test average comparison, p=0.033). No association was found between complications and age, ECOG, respiratory function, EF, CCI, levels of creatinine/potassium in the blood. Preoperative dialysis duration did not affect complications, but influenced the lenght of hospital stay according to an inverse correlation ( Table 9 ). Table 9 Grouped lenght of stay N Average Std. Deviation Dialysis duration (months) 11 9 13,33 12,104 Significant correlation between dialysis duration and lenght of hospital stay (T-test average comparison, p=0.009). Conversely the lenght of hospital stay was not affected by CCI. Regarding blood complications, the analysis found an association between preoperative hemoglobin and need for transfusion (Table 10). Table 10 Postop transfusion N Average Std. Deviation Preoperative Hemoglobin no 11 12,773 1,2133 si 8 11,388 1,4904 Significant correlation between preoperaive hemoglobin and Postoperative transfusion (T-test average comparison, p=0.039). We also found a statistical significant association betwen transfusion and complications (Table 11). Table 11 Complications Total no yes Postop Transfusion no Count 6 5 11 % postop transfusion 54,5% 45,5% 100,0% % complications 100,0% 38,5% 57,9% % of the total 31,6% 26,3% 57,9% yes Count 0 8 8 % postop transfusion 0,0% 100,0% 100,0% % complications 0,0% 61,5% 42,1% % of the total 0,0% 42,1% 42,1% Total Count 6 13 19 % postop transfusion 31,6% 68,4% 100,0% % complications 100,0% 100,0% 100,0% % of the total 31,6% 68,4% 100,0% Significant correlation between transfusion and complications (T-test average comparison, p=0.012). Regarding mortality, no statistical significant association was founded with variables under study. The type of surgery did not influence complications (Table 12) , or survival (Figure 3) . Table 12 Complications Total no yes Type of surgery lobectomy Count 4 9 13 % type of surgery 30,8% 69,2% 100,0% % complications 66,7% 69,2% 68,4% % of the total 21,1% 47,4% 68,4% wedge Count 2 4 6 % type of surgery 33,3% 66,7% 100,0% % complications 33,3% 30,8% 31,6% % of the total 10,5% 21,1% 31,6% Total Count 6 13 19 % type of surgery 31,6% 68,4% 100,0% % complications 100,0% 100,0% 100,0% % of the total 31,6% 68,4% 100,0% Correlation not significant between type of surgery and complications (T-test average comparison, p=0.911). The analysis of survival curves highlited that survival is unfavorably affected by advanced age and stage (Figure 4-5). The relation between ECOG and complications are at the limits of statistical significance (p value 0,061 and 0,063 respectively). No significant associations were found between survival, sex, repiratory function, levels of creatinine and potassium in the blood, dialysis duration and CCI. Discussion The present work is a multicenter retrospective observational study that focuses on the outcomes of lung surgery for cancer performed on hemodialysis patients. Postoperative complication rate was 84%, 26% of which for hemmorhage and 21% iperkalemia. Regarding complications in other studies, these vary from 27–100%. A deitailed analysis shows that complications most frequently in other studiese are: pnemonia [ 4 , 6 , 7 , 10 , 11 , 12 , 14 , 15 ], atrial fibrillation [ 4 , 5 , 8 , 12 , 13 ], iperkalemia [ 4 , 5 , 11 , 14 ] and bronchial obstruction [ 4 , 5 , 8 , 11 ]. The use of blood transfusion was necessary in 47% of cases and 68% of patients had a drop in preoperative hemoglobin values. The association between the two events was statisticallly significant, thus implying the need for careful monitoring of hemoglobin values and eventually the preoperative use of erythropoiesis stimulating agents or iron, according to international guidelines. Furthermore, having found the association between transfusion and risk of complications, it would be amenable to reduce the use of this practice. Many studies have recorded the frequent use of nafamostat mesilato (drug used in Japan) as anticoagulant during dialysis [ 4 , 10 , 11 , 13 , 14 ]. In contrast to heparin, it prolongs clotting time only in extracorporeal circuit; it is used in Japan in patients at high risk of bleeding. In contrast, Tomizawa e Watanabe [ 11 , 13 ], consideringthe absence of bleeding with the use of heparin, they believe that this drug can be used safely. According to data reported by Ciriaco [ 5 ], the bleeding risk is minimized by reducing the heparin dosage. In Tsuchida’s study [ 4 ] the use of antiplatelets an anticoagulants drugs did not affected bleeding. Perioperative management involves careful monitoring hydoelectrolyte balance. In this regard, many authors consider it is useful monitoring with central venous catheter and an arterial catheter [ 4 , 6 ]. Ciriaco [ 5 ] demonstrated that preoperative dialisys performed two consecutive days before surgery and the day after surgery reduced the extent of hydrolytic imbalances. According to the date reported by Watanabe [ 13 ], in our study 89% of patients (17/19) performed the last dialysis session the day before surgery. First hemodialysis session was performed in 10 cases on day after surgery and in 5 cases two days after surgery. Emergency dialysis was necessary in 6 patients, in 5 patients due to excessively high level of potassium and in one case due to acute pulmonary edema. Morita [ 16 ] reported association between postoperative potassium level and the increase in creatinphosphokinase values (CPK) and the extension of muscle resection. Since video thoracoscopy requires less muscle resection than thoracotomy, it is believed that this may be advantageous in reducing potassium levels [ 8 , 10 ]. Obuchi [ 7 ] compared population undergoing thoracotomy vs videothoracoscopy: no statistically significant differences were found in this study regarding duration of surgery, bleeding, duration of drainage and length of hospital stay. In our case stady, such comparison was not possible due to the small number of patients undergoing minimally invasive surgery. In this study the risk of complications was associate to smoke. Both the incidence of complications and hospital stay were significantly higher than the general population (average 17 days, median 11 days). Hospitalization was associated to duration of preoperative dialysis according to an inverse correlation. This probably is due to the fact that these patients require a longer period of adaptation, therefore a longer period of hospitalization; instead those on dialysis for the longest time have already achieved a good balance, therefore the duration of hospitalization is not affected significantly by dialysis. From the analysis of the literature, the correlation between smoke and complications is confirmed by Watanabe [ 13 ], who also identifies an association with the duration of surgery. Yamamoto [ 12 ] identifies as a risk factor for complications large lung resections and hystory of stroke. In this study we don’t found association between type of surgery and complications. Furthermore in our case sudy there is only one patient with history of ictus, died after surgery; he had severe vasculopaty and arterial hypertension. Other authors note a greater risk of complications subjects with cardiovascular comorbidities or reduced respiratory function [ 6 , 14 ]. Tomizawa [ 11 ] identifies an association between complications and CCI; also he highlights the risk of exacerbation of interstitial pulmonary disease is greater in dialysis patients than general population (50% vs 9,3%) [ 17 ]. In this case study the postoperative mortality rate (30 days after surgery) is 5%, because one patient died 27 days after surgery. Table 13 shows the results of the studies, in the last twenty years, about hemodialysis patients undergoing to surgery for lung cancer, excluded case reports. Table 13 Autore Anno di pubblicazione Numero di pazienti n° pazienti in stadio Ia (%) Morbilità % Mortalità % OS 5 anni % Morita et al. 2001 5 1 (20) 60 0 ND Tsuchida et al. 2001 7 1 (14) 100 14 ND Ciriaco et al. 2005 6 3 (50) 57 0 50 Obuchi et al. 2009 11 6 (55) 27 0 28 Takahama et al. 2010 24 10 (42) 59 0 43 Obuchi et al. 2011 14 8 (57) 29 0 40 Suehir et al. 2011 21 ND 76 0 ND Matsuoka et al. 2013 5 1 (20) 40 0 60 Park et al. 2015 7 2 (29) 43 14 34 Otsuki et al. 2018 7 4 (50) 43 0 25 Tomizawa et al. 2019 21 8 (38) 67 5 26 Yamamoto et al. 2020 39 27 (69) 31 8 58 Watanabe et al. 2020 38 ND 49 0 ND Presente studio 2024 19 10 (53) 84 5 29 Study results on hemodialysis patients undergoing resection for lung cancer. From data present in the literature, it is note that postoperative mortality rate varies from 0 to 14%, therefore, our date is placed in the first half of the distribution. In-hospital mortality was remarkable (10,5%), but not higher than that previously reported in other studies. Postoperative mortality in hemodialysis patients is higher than general population: 6% for pneumonectomy, 3% for lobectomy and less than 1% for wedge resections [ 18 ]. As for long term results, OS at 3 and 5 years was respectively 46% and 29%. In other studies 5 years OS varies from 25–60%, therefore our data is in the average of that reported in literature. According to data from SEER (Surveillance, Epidemiology and End Results del National Cancer Institute), 5 years OS for lung cancer is 26,7%. Considering survival by stage, 5 years OS is 63,7% for early-stage, 35,9% for involvement of regional lymph node; 8,9% for metastatic tumors; 15,6% for unstaged forms [ 19 ]. So if we consider that patient scheduled for sugery have early-stage tumors, OS of 29% is lower than OS of general population (59,8%). However in our study there were also some stage III patients which may have worsened overall survival. Furthermore, it must be considered mortality due to causes other than cancer which is also high in other studies. Table 14 reports, for each published study, the number of deaths from causes other than cancer: the total number of deaths was 79, of which 63% were non cancer-related, witnessing the impact of chronic renal failure and comorbidities on survival. Indeed, according to Japanese’s report of Society of Dialysis Therapy, survival of dialysis patients is 61% at 5 years, 37% at 10 years and 23% at 15 years [ 21 ]; while, according to date of Italian society of nephrology, annual mortality is 17% [ 20 ]. Table 14 Autore Anno di pubblicazione Numero di pazienti N° morti N° morti per cancro N° di morti per altro % N° di morti per altro Morita et al. 2001 5 3 0 3 100 Tsuchida et al. 2001 7 5 3 2 40 Ciriaco et al. 2005 6 1 0 1 100 Obuchi et al. 2009 11 6 2 4 67 Takahama et al. 2010 24 8 6 2 25 Obuchi et al. 2011 14 7 3 4 57 Suehir et al. 2011 21 ND ND ND ND Matsuoka et al. 2013 5 2 1 1 50 Park et al. 2015 7 4 3 1 25 Otsuki et al. 2018 7 3 2 1 33 Tomizawa et al. 2019 21 9 3 6 67 Yamamoto et al. 2020 39 17 3 14 82 Watanabe et al. 2020 38 ND ND ND ND Presente studio 2024 19 14 3 11 58 Totale 79 29 50 59 Causes of death in hemodialysis patients undergoing lung surgery for cancer Therefore, while the data on OS seem disappointing, the data on DFS are more comforting. Out of 14 dead patients, only 4 showed disease recurrence and only 2 dead from cancer. DFS is definitely higher: 77% at 3 years 62% at 5 years. Also Yamamoto [ 17 ] reports similar data on DFS: 66,5% for stage Ia and 52,9% for othe stages at 5 years. In this study, the analysis of survival curves highlighted that survival is adversely affected by advanced age and stage. These correlations have been extensively studied in literature, so it isn’t surprising that in our analysis resulted significant. The survival was not affected by type of surgery instead, this leading to reflection that major resections should not be denied in properly selected patients (young and with early-stage disease). An interesting fact is that during of dialysis does not influence survival or complications. Conclusions The limitations of this work are: retrospective study and small sample size. Furthermore, the data collection is spread over twenty years, therefore it isn’t considered progress in recent years about surgical techiques with the introduction of new technoligies, improvements in dialysis technique and in chronic management of dialisys patient resultingin increased survival. Despite the limitations considered, a significant fact is certainly the association between smoke and complications, therefore smokers are considered at risk. Furthermore, results regarding bleeding indicate to pay attention to the management of these aspects, both preoperatively and postoperatively. The results of the present study, in particular those about OS and DFS, demonstrates that surgery for lung cancer is a reliable therapeutic option in patients with end-stage chronic renal failure: accurate patients selection and careful perioperative management are mandatory to minimize complications since most of patients die from non cancer-related events. Abbreviations OS (5-years overall survival); DFS (5-years Disease free survival); FEV1 (Forced Expiratory Volume in 1 second); DLCO (Diffusing capacity of the lungs for carbon monoxide); FE (Ejection Fraction); CCI (Charlson Comorbidity Index); ECOG (Eastern Cooperative Oncology Group); COPD (Chronic Obstructuve Pulmonary Disease); CPK (creatinphosphokinase values); SEER (Surveillance, Epidemiology and End Results del National Cancer Institute). Declarations COMPETING INTERESTS The authors declare no competing interests. FUNDING No funding available for this work. Author Contribution E. C.,C. R., CB wrote the main manuscript text. C.R. prepared figures. D.B., A.S., P.F. contributed to the data collection.All authors reviewed the manuscript. Acknowledgement We thank all of doctors who operate in the partecipating centers and who have contribuited to the database. This study was partially supported by Italian Ministry of Health – Ricerca Corrente Annual Program 2026. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References ECOG PERFORMANCE STATUS As published in Am. J. Clin. Oncol.: Oken, M.M., Creech, R.H., Tormey, D.C., Horton, J., Davis, T.E., et al.: Toxicity And Response Criteria Of The Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649-655, 1982. M E Charlson, P Pompei, K L Ales, C R MacKenzie. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83 Daniel Dindo , Nicolas Demartines, Pierre-Alain Clavien. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. Tsuchida M, Yamato Y, Aoki T et al. Complications associated with pulmonary ung resection in lung cancer patients on dialysis. Ann Thorac Surg 2001;71:435-8 Ciriaco P, Casiraghi M, Melloni G et al. Pulmonary resection for non-small-cell lung cancer in patients on hemodialysis: clinical putcome and long-term results. World J Surg 2005;29.1515-19. Takahama M, Yamamoto R, Nakajima R et al. Pulmonary resection for lung cancer patients on chronic hemodialysis: clinical outcomes and long-term results after operation. Interact cardiovasc thorac surg 2010;11:150-3. Obuchi T, Imakiire T, Nakashina H et al. Video-assisted thoracic surgery for lung cancer in hemodialysis patients. Asian J Endosc Surg 2011;4:157-60 Matsuoka K, Kuroda A, Kang A et al. Video-assisted thoracoscopic surgery for lung cancer in patients on hemodialysis. Ann Thorac Cardiovasc Surg 2013;19:263-7 Park BJ, Shin S, Kim HK et al. Surgical treatment for non-small cell lung cancer in patients on hemodialysis due to chronic kidnely disease: clinical outcome and intermediate-term results. Korean J Thorac Cardiovasc Surg 2015;48:193-8. Otsuki Y, Kuwahara H, Konn H. Outcomes, safety and feasibility of video-assisted thoracic surgery in lung cancer patients on hemodialysis: a case series. Gen Thorac Cardiovasc Surg 2018:66-48-53 Tomizawa K, Sato K, Ohara S et al. Life-threatening complications after pulmonary resection for lung cancer in patients on chronic hemodilaysis. Surg today 2019;49:513-20. Yamamoto Y, Kanzaki R, Ose N et al. Lung cancer surgery for patients on hemodialysis: a decade of experience at a multicenter institutions. Ann Thorac Surg 2020;109:1558-65. Watanabe Y, Hattori A, Fukui M et al. Postoperative complications and perioperative management in patients on hemodialysis undergoing lung resection. Gen Thorac Cardiovasc Surg, 2020, September 28. DOI:10.1007/s11748-020.01489-x. Koichi Suehiro and Ryu Okut. Perioperative Complications in Patients with End-Stage Renal Disease Undergoing Pulmonary Resection. Suehiro and Okutani J Anesthe Clinic Res 2011, 2:3 Obuchi T, Hamanaka W, Yoshida Y, et al. Clinical outcome after pulmonary resection for lung cancer patients on hemodialysis. Ann Thorac Surg.2009 Morita T, Tachibana S, Kawakami M, et al. Pulmonary lobectomy for lung cancer in patients on chronic hemodialysis. Jpn J Chest Surg 2001; 15: 454-8. (in Japanese) Sato T, Teramukai S, Kondo H, Watanabe A, Ebina M, et al. Impact and predictors of acute exacerbation of interstizial lung diseases after pulmonary resection for lung cance. J Thoracic Cardiovasc Surg. 2014;147:1604-11. Watanabe S, Asamura H, Suzuki K et al. Recent results of post operative mortality for surgical resection in lung cancer. Ann Thor Surg 2004;78:999-1003. https://seer.cancer.gov/statfacts/html/lungb.html https://ridt.sinitaly.org/category/registro-nazionale The Japanese Society of Dialysis Therapy (JSDT). About JSDT. Available at: https://docs.jsdt.or.jp/overview/. Accessed: January 20, 2020. Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6680380","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":511679103,"identity":"80949f89-a61b-4fbc-b419-567d940d3fec","order_by":0,"name":"Elena Carrese","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYDACdhReBVxEArcWZhTeGbiIBG49KFoY2xAiOLXwMzMfe/CDwU7efPbhwx8+zrNLnN/MwPbhA4NFHS4tks1s6YY9DMmGc86lpUnO3JacuOEwA/PMGXgcZnCYx0yCh+EA4wweHjNm3m3MiRuYGZiZefBosT/M/03yD8MB+xk8/J8//51TD3IYM/MffLYw87BJA21JBNrCIM3YcDixAegwZnwhJnGYzUxaxiA5eQYPm5lkz7HjxhsOMzYz9hhISDbg0MLf3vxM8k2Fne0MHubHH37UVMvOb28+zPCjoo4fly1Q56HwGBvQRUbBKBgFo2AUkAgA+wlE6Kx8ek8AAAAASUVORK5CYII=","orcid":"","institution":"Unit of Thoracic Surgery Azienda USL-IRCCS di Reggio Emilia","correspondingAuthor":true,"prefix":"","firstName":"Elena","middleName":"","lastName":"Carrese","suffix":""},{"id":511679104,"identity":"557b81d9-969f-4717-8104-d7c6f64b5422","order_by":1,"name":"Cristian Rapicetta","email":"","orcid":"","institution":"Unit of Thoracic Surgery Azienda USL-IRCCS di Reggio Emilia","correspondingAuthor":false,"prefix":"","firstName":"Cristian","middleName":"","lastName":"Rapicetta","suffix":""},{"id":511679105,"identity":"2325abd6-3142-44e1-a16b-271bd46a0cce","order_by":2,"name":"Alessandro Stefani","email":"","orcid":"","institution":"Unit of Thoracic Surgery Azienda Policlinico-Universitaria di Modena","correspondingAuthor":false,"prefix":"","firstName":"Alessandro","middleName":"","lastName":"Stefani","suffix":""},{"id":511679106,"identity":"1d1ea109-6134-4b75-af5f-7ed8bf8e532c","order_by":3,"name":"Tommaso Ricchetti","email":"","orcid":"","institution":"Unit of Thoracic Surgery Azienda USL-IRCCS di Reggio Emilia","correspondingAuthor":false,"prefix":"","firstName":"Tommaso","middleName":"","lastName":"Ricchetti","suffix":""},{"id":511679107,"identity":"6315c057-7398-442b-bf07-de188a8f601c","order_by":4,"name":"Alberto Matricardi","email":"","orcid":"","institution":"Unit of Thoracic Surgery Azienda USL-IRCCS di Reggio Emilia","correspondingAuthor":false,"prefix":"","firstName":"Alberto","middleName":"","lastName":"Matricardi","suffix":""},{"id":511679108,"identity":"5fe8ba09-2957-4f8d-8fd3-b4e77ebb8a85","order_by":5,"name":"Daniel Bianchi","email":"","orcid":"","institution":"Unit of Thoracic Surgery Azienda USL-IRCCS di Reggio Emilia","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Bianchi","suffix":""},{"id":511679109,"identity":"49021e08-5e74-4ee9-b39f-583b17c0ab1f","order_by":6,"name":"Candida Bonelli","email":"","orcid":"","institution":"Unit of Thoracic Surgery Azienda USL-IRCCS di Reggio Emilia","correspondingAuthor":false,"prefix":"","firstName":"Candida","middleName":"","lastName":"Bonelli","suffix":""},{"id":511679110,"identity":"bed7693e-9459-46f0-8cba-ce6d98e68d0b","order_by":7,"name":"Pier Luigi Filosso","email":"","orcid":"","institution":"Unit of Thoracic Surgery Azienda Policlinico-Universitaria di Modena","correspondingAuthor":false,"prefix":"","firstName":"Pier","middleName":"Luigi","lastName":"Filosso","suffix":""},{"id":511679111,"identity":"1e1982d1-a5ab-411b-ba3a-8b5faf46e8ce","order_by":8,"name":"Massimiliano Paci","email":"","orcid":"","institution":"Unit of Thoracic Surgery Azienda USL-IRCCS di Reggio Emilia","correspondingAuthor":false,"prefix":"","firstName":"Massimiliano","middleName":"","lastName":"Paci","suffix":""}],"badges":[],"createdAt":"2025-05-16 11:38:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6680380/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6680380/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90909177,"identity":"a0d27423-595a-4128-a7a0-08c13fb3c865","added_by":"auto","created_at":"2025-09-09 13:29:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1513878,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe Kaplan-Meier survival curve represents the Overall survival. OS at 1, 3 and 5 years is 63%, 46% and 29% respectively.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6680380/v1/5b9298b7a4784b5928750d95.png"},{"id":90909181,"identity":"b2e7f72c-ad8c-4bc9-afad-02ee9086b773","added_by":"auto","created_at":"2025-09-09 13:29:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1083177,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe Kaplan-Meier survival curve represents the Disease-free survival. DFS at 1, 3 and 5 years is 93%, 77% and 62% respectively.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-6680380/v1/46282b254dd28d0cdb545822.png"},{"id":90909180,"identity":"2efdbc40-8c44-425c-990b-9780fe0390bb","added_by":"auto","created_at":"2025-09-09 13:29:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2764690,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSurvival curve in relation to type of surgery.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-6680380/v1/136a3ab1abdd68bcaaa3afdf.png"},{"id":90912010,"identity":"097d73c7-70bf-49a0-a887-1a082f85988c","added_by":"auto","created_at":"2025-09-09 13:45:22","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2890416,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe survival curves highligth a significantly better survival in young patients, (≤72 years old vs \u0026gt;72 years old), with 73% Vs 0% 5-yrs survival rates respectively and a Median Survival of 87 and 7 months respectively (p\u0026lt;0,08).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-6680380/v1/d4034d51f9a70029ceced565.png"},{"id":90912880,"identity":"7f35ef76-f712-402e-94ae-b7383eada66c","added_by":"auto","created_at":"2025-09-09 13:53:26","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":2823690,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe survival curves highligth a significantly better survival in early stage (p\u0026lt;0,019).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-6680380/v1/44e0d3e60d8f36cd7af3b5d5.png"},{"id":91480148,"identity":"b550c609-0f65-4b23-b272-7e36c005d4f7","added_by":"auto","created_at":"2025-09-17 02:47:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":15216649,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6680380/v1/45a75b63-4651-4feb-9313-28790e8550d2.pdf"},{"id":90909170,"identity":"65e4ac3b-931a-4cf5-aa98-3aca61473007","added_by":"auto","created_at":"2025-09-09 13:29:21","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16347,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6680380/v1/693a1075a6e787e980daf0ed.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Outcome of Lung Cancer Surgery in Patients on Chronic Hemodialysis: A Multicenter Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe number of end-stage renal disease patients on hemodialysis is on the rise worldwide. The prognosis of these patients has improved due to advances in dialysis techniques leading to decrease in incidence of death for cardiovascular disease. Conversely the incidence of infection and malignant disease is increasing instead. The relative risk of lung cancer, unlike other types of cancer, does not seem to be higher than normal population, but as the prevalence of patient on hemodialysis increases, the number of surgery resections for lung cancer is expected to increase.\u003c/p\u003e\u003cp\u003eThe management of systemic therapy for lung cancer is very complex in patient receveing hemodialysis and there is little data avaible about target therapy and immunotherapy. Patients on dialysis represent a high risk group beacause of cardiovascular disease, diabete mellitus, electrolyte imbalance, hemodynamic instability, metabolic disorder, anemia, bleeding tendency, immunosoppression. These problems can lead to post-operative complication, requiring careful peri-operative management. However, there are only few reports about pulmonary resection in hemodialysis patients with lung cancer.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This study was approved by Ethics Committee of Azienda USL-IRCCS of Reggio Emilia (207/2021/OSS/IRCCSRE on 27/4/2021).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003cp\u003e declarations: not applicable according to national regulations\u003c/p\u003e\u003c/p\u003e\u003cp\u003e(GDPR n. 679/2016, del D. Lgs. 196/2003, come modificato dal D. Lgs. 101/2018 e dal Provvedimento del Garante per la protezione dei dati personali n. 146 del 05/06/2019).\u003c/p\u003e\u003cp\u003e The authors declare that all methods were performed in accordance with ethical guidelines.\u003c/p\u003e\u003cp\u003eThis is a multicenter retrospective observational study who involves hemodialysis patients undergoing pulmonary resection for lung cancer in the last 20 years (2000\u0026ndash;2021) in 3 different Thoracic Surgery Centers. Patients undergoing peritoneal dialysis and who have started dialysis in perioperative period were excluded.\u003c/p\u003e\u003cp\u003eThe variables collected were:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePreoperative: sex, age, smoking habit, performance status, body mass index, FEV1 (Forced Expiratory Volume in 1 second), DLCO (diffusing capacity of the lungs for carbon monoxide), PaO2, PaCO2, cardiac Ejection Fraction (EF), Charlson Comorbidity Index (CCI), taking antiplatelet/anticoagulant drugs, type of nephropaty, duration of hemodialysis, serum urea, creatinine, potassium, hematocrit, hemoglobin, total proteins (the values are referred to the day before the operation), time elapsed between the last hemodilysis session and the operation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIntraoperative: type of surgical access (Thoracoscopy ot thoracotomy), type of intervention, type of limphadenectomy, duration of the intervention, intraoperative bleeding.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePostoperative: serum potassium value, time interval between operation and the first hemodialysis session, need for urgent dialysis sessions, postoprative complications (typology of complications and severity according to Clavien-Dindo classification), need for blood transfusions, admission to intensive care, duration of drainage, length of post-operative hospital stay.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRelated to the neoplasm: clinical stage, pathological stage, hystotype.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFollow-up: patient status (alive/dead), presence of recurrence, site of recurrence, cause of death, overall survival and cancer related survival and disease free survival at 1,2,3,4,5.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTimes: dialysis start date, date of surgery, date of last observation, recurrence date, death date.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eClassifications used are:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eECOG (Eastern Cooperative Oncology Group) Performance status;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCharlson Comorbity Index;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eClavien-Dindo Classification of complications.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003ePerformance statuts is an evalution of patient\u0026rsquo;s general conditions and daily life skills. ECOG scale, published by Oken et al. nel 1982 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], allows to assign a score from 0 to 5, where 0 indicates perfect health while 5 indicats death.\u003c/p\u003e\u003cp\u003eCharlson Comorbity Index (CCI) is used to classify comorbidities that affect mortality risk [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. 19 medical conditios are considered (16 diseases, 3 of which are stratified according to gravity); each is given a score from 1 to 6, with final score from 0 to 33. Score is adjusted with age, getting a combined age comorbity index from 0 to 37.\u003c/p\u003e\u003cp\u003eClavien-Dindo Classification is a complication subdivision system [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eDescriptive Statistics: categorical variables were expressed as frequencies and percentages. Continuous variables were expressed by mean +/- standard deviation or median and interquartil range.\u003c/p\u003e\u003cp\u003eAnalytical Statics: preoperative and intraoperative variables were analysed with complications to identify possible associations. Comparison between categorical variables was performed with Chi square test (Fischer exact-test correction was used for small samples as indicated); continuous variables were compared with Student\u0026rsquo;s T-Test or ANOVA. The variables arranged in ranks were compared with non-parametric tests (Mann-Whitney or Kruskal-Wallis). As cut-off for the categorization of continuous variables in 2 subgroups median value of variable was used.\u003c/p\u003e\u003cp\u003eSurvival was considered from intervention to last observation date (OS) or. from intervention to recurrence date (DFS), if present. The OS and DFS were computed by the Kaplan-Meier method, and differences between groups calculated using the Log-Rank test.\u003c/p\u003e\u003cp\u003eSome statistical tests, given the small sample size, had not been carried out because of low reliability. All statistical analyses were performed using SPSS 26.0 (SPSS inc., Chicago, IL).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eCharacteristics of the patients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatients\u0026apos;s characteristics are shown in the \u003cem\u003eTable 1\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study includes 19 patients, mostly men (15/17, 79%), with an average age of 71 years. All subjects were smokers or former smokers. Nephroangiosclerosis and Glomerulonephritis were the main causes of end-stage renal failure (37% and 32% respectively). The average duration of dialysis was 27 months. The last dialysis for surgery was performed the day before surgery in all but 2 patients. Regarding respiratory function, the values of FEV1% were \u0026lt;80% in 3 patients (16%), PaO₂\u0026lt;80 mmHg in 3 cases (16%). All patients had an echocardiogram with cardiac ejection fraction values \u0026lt;50% in 4 cases (21%). Regarding biohumoral tests, urea and creatinine were obviously high on average, while potassium value and serum proteins were well controlled. Most patients presented preoperative anemia (68%). Eleven patients (58%) were taking antiplatelets drugs (8/10), including acetylsalicylic acid, clopidogrel and ticlopidine, or warfarin and enoxaparin as anticoagulants (2/10). For one patient it is unknown whether he took antiplatelets or anticoagulants.\u003c/p\u003e\n\u003cp\u003eCharlson Comorbidity Index has a maximum of 37 points, but in this study the maximum score was 13. Most patients had a score between 6-10. Most common comorbidities were arterial hypertension (13 cases), chronic peripheral vascular disease, chronic ischemic heart disease, presence of other malignant neoplasm and COPD (Chronic Obstructuve Pulmonary Disease) (\u003cem\u003eTable 2\u003c/em\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 2\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"309\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eArterial Hypertension\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e13 (68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eChronic Vascuolopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eChronic ischemic heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eNeoplasm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e5 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eCOPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e4 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eEpatopathy HCV-related\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2 (10,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eInsulin-dependent Diabetes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2 (10,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eAtrial Fibrillation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2 (10,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eStroke oucomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1 (5,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eChronic Respiratory Failure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1 (5,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eCardiac valvulopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1 (5,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 216px;\"\u003e\n \u003cp\u003eEpilepsy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1 (5,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Comorbidities\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePerioperative Variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe \u003cem\u003eTables 3 and 4\u003c/em\u003e summarize variables related surgery and postoperative period. In 16 patients surgical access was thoracotomy, while only 3 patients underwent videothoracoscopy, lobectomy was performed in most patients (68%) and in all cases the intervention was radical.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 3\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"359\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.0947%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.6267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.0947%;\"\u003e\n \u003cp\u003eType of intervention\u003c/p\u003e\n \u003cp\u003e- Lobectomy\u003c/p\u003e\n \u003cp\u003e- Wedge resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.6267%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (68%)\u003c/p\u003e\n \u003cp\u003e6 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.0947%;\"\u003e\n \u003cp\u003eType of linfoadenectomy \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- Sampling\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- Radical\u003c/p\u003e\n \u003cp\u003e- None\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.6267%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (74%)\u003c/p\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003cp\u003e3 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.0947%;\"\u003e\n \u003cp\u003eDuration of intervention (min)\u003c/p\u003e\n \u003cp\u003e- Average\u003c/p\u003e\n \u003cp\u003e- Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.6267%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003cp\u003e(67-260)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74.0947%;\"\u003e\n \u003cp\u003eIntraoperative blood loss (mL)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- Average\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25.6267%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e266\u003c/p\u003e\n \u003cp\u003e(0-2000)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eIntraoperative Variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe results about complications were: sixteen patients (84%) presented postoperative complications (included hyperkalemia), ranked according Clavien-Dindo Classification. The \u003cem\u003eTable 4\u0026nbsp;\u003c/em\u003eshows the list of complications. 10 patients presented only one complication, 3 patients 2 complications and 3 patients 3 complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 4\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"353\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003eHemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e5 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003eHyperkalemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e4 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003ePneumonia/lung abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e3 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003eRespiratory failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e3 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003eProlonged air loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e2 (10,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003eAcute Respiratory Distress Syndrome (ARDS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e1 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003eAtelecyasis/Bronchial obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e1 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003eHeart Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e1 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003eAcute Myocardial Infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e1 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003ePulmonary Edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e1 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75.1773%;\"\u003e\n \u003cp\u003eIntestinal Perforation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24.8227%;\"\u003e\n \u003cp\u003e1 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eList of postoperative complications\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTransfusion was necessary in 9 patients for hemoglobin value \u0026lt;8 g/dL and admission in Intensive care in 9 patients (7 patients of which for respiratory or multiple organs failure). Emergency dialysis was performed in 6 patients, in 5 for hyperkalemia and in 1 case for acute pulmonary edema. In the last cases the first postoperative dialysis was performed in 10 cases on the first post-operative day and in 5 cases two days after surgery. 30-day mortality was 5%, because one patient died after 27 days. If we consider in-hospital mortality, the percentage rises to 10,5%, because one patient died 37 days after surgery. The cause of death was multiple organ failure in both cases. They both had a CCI of 9 and had undergone lobectomy and wedge resection repectively. \u0026nbsp; \u0026nbsp;The table 5 shows Post-operative Variables\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 5\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"436\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 260px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 260px;\"\u003e\n \u003cp\u003ePostop Potassium (mmol/L)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e- Average\u003c/p\u003e\n \u003cp\u003e- Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4,2\u003c/p\u003e\n \u003cp\u003e3,2-8,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 260px;\"\u003e\n \u003cp\u003eEmergency dialysis\u003c/p\u003e\n \u003cp\u003e- Yes\u003c/p\u003e\n \u003cp\u003e- No\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (32%)\u003c/p\u003e\n \u003cp\u003e13 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 260px;\"\u003e\n \u003cp\u003ePostoperative complications\u003c/p\u003e\n \u003cp\u003e- Yes\u003c/p\u003e\n \u003cp\u003e- No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (84%)\u003c/p\u003e\n \u003cp\u003e3 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 260px;\"\u003e\n \u003cp\u003eClavien \u0026ndash; Dindo Classifications\u003c/p\u003e\n \u003cp\u003e- I\u003c/p\u003e\n \u003cp\u003e- II\u003c/p\u003e\n \u003cp\u003e- III\u003c/p\u003e\n \u003cp\u003e- IV\u003c/p\u003e\n \u003cp\u003e- V\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (21%)\u003c/p\u003e\n \u003cp\u003e5 (26%)\u003c/p\u003e\n \u003cp\u003e2 (10,5%)\u003c/p\u003e\n \u003cp\u003e6 (32%)\u003c/p\u003e\n \u003cp\u003e2 (10,5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 260px;\"\u003e\n \u003cp\u003eBlood transfusion\u003c/p\u003e\n \u003cp\u003e- Yes\u003c/p\u003e\n \u003cp\u003e- No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (47%)\u003c/p\u003e\n \u003cp\u003e10 (53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 260px;\"\u003e\n \u003cp\u003eIntensive care admission\u003c/p\u003e\n \u003cp\u003e- Yes\u003c/p\u003e\n \u003cp\u003e- No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (47%)\u003c/p\u003e\n \u003cp\u003e10 (53%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 260px;\"\u003e\n \u003cp\u003eDuration of drainage (days)\u003c/p\u003e\n \u003cp\u003e- Average\u003c/p\u003e\n \u003cp\u003e- Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2-69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 260px;\"\u003e\n \u003cp\u003ePost-operative hospital stay (days)\u003c/p\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(6-54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003ePost-operative Variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eVariables related to tumor and survival\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 6\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"303\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHistological type\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u003cem\u003eAdenocarcinoma\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e12 (63)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u003cem\u003eSquamous cell carcinoma\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e6 (32)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u003cem\u003eOther\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cem\u003e1 (5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eVariables related to hystological type\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHistologically, the most common tumor was adenocarcinoma (\u003cem\u003eTable 6\u003c/em\u003e), according to the increased incidence in the whole population. Most of patients were in stage I (15/19, 79%), as represented in the \u003cem\u003eTable 7\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 7\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"142\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cem\u003eIa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cem\u003e10 (53)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cem\u003eIb\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cem\u003e5 (26)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cem\u003eIIa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cem\u003e0 (0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cem\u003eIIb\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cem\u003e2 (11)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cem\u003eIIIa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cem\u003e2 (11)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eStage-related Variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe average follow-up was 34 months. At the end of follow up 14 patients died (74%), including the 2 post-operative deaths. Only 1 patient died of cancer (5%), while 13 patients died of other causes. 4 patients relapsed (21%), 3 loco-regional recurrences and 1 cerebral recurrence. 2 of these patients died after 29 and 38 months, one patient died 11 months later, while one patient was alive after 63 months, with a recurrence within 8 months. Median overall survival was 4 months. The OS and DFS are showed in\u003cem\u003e\u0026nbsp;Figure 1\u003c/em\u003e and \u003cem\u003e2\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding the preoperative and perioperative factors affecting the development of complications, the only statistically significant association involved the smoking habit. Patients with an important story of cigarette use had a higher incidence of complications (\u003cem\u003eTable 8\u003c/em\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 8\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"499\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003ecomplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 79px;\"\u003e\n \u003cp\u003epack/years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e19,50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e6,595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e0,033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003esi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e39,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e19,684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSignificant correlation between smoke and complications (T-test average comparison, p=0.033).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo association was found between complications and age, ECOG, respiratory function, EF, CCI, levels of creatinine/potassium in the blood.\u003c/p\u003e\n\u003cp\u003ePreoperative dialysis duration did not affect complications, but influenced the lenght of hospital stay according to an inverse correlation (\u003cem\u003eTable 9\u003c/em\u003e).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"528\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 9\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003eGrouped lenght of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 131px;\"\u003e\n \u003cp\u003eDialysis duration (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026lt;=11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e36,90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e20,798\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026gt;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e13,33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e12,104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSignificant correlation between dialysis duration and lenght of hospital stay (T-test average comparison, p=0.009).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConversely the lenght of hospital stay was not affected by CCI.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding blood complications, the analysis found an association between preoperative hemoglobin and need for transfusion \u003cem\u003e(Table 10).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 10\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"521\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 164px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003ePostop transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 164px;\"\u003e\n \u003cp\u003ePreoperative Hemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e12,773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1,2133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003esi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e11,388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1,4904\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSignificant correlation between preoperaive hemoglobin and Postoperative transfusion (T-test average comparison, p=0.039).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe also found a statistical significant association betwen transfusion and complications \u003cem\u003e(Table 11).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 11\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"539\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" style=\"width: 124px;\"\u003e\n \u003cp\u003ePostop Transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 49px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e% postop transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e54,5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e45,5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e% complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e38,5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e57,9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e% of the total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e31,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e26,3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e57,9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 49px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e% postop transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e% complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e61,5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e42,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e% of the total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e42,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e42,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" style=\"width: 173px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e% postop transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e31,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e68,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e% complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 164px;\"\u003e\n \u003cp\u003e% of the total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e31,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e68,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSignificant correlation between transfusion and complications (T-test average comparison, p=0.012).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRegarding mortality, no statistical significant association was founded with variables under study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe type of surgery did not influence complications \u003cem\u003e(Table 12)\u003c/em\u003e, or survival \u003cem\u003e(Figure 3)\u003c/em\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"548\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 548px;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 12\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 346px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" style=\"width: 109px;\"\u003e\n \u003cp\u003eType of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 81px;\"\u003e\n \u003cp\u003elobectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e% type of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e30,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e69,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e% complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e66,7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e69,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e68,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e% of the total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e21,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e47,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e68,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 81px;\"\u003e\n \u003cp\u003ewedge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e% type of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e33,3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e66,7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e% complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e33,3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e30,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e31,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e% of the total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e10,5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e21,1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e31,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" style=\"width: 190px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e% type of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e31,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e68,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e% complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e% of the total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e31,6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e68,4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e100,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eCorrelation not significant between type of surgery and complications (T-test average comparison, p=0.911).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis of survival curves highlited that survival is unfavorably affected by advanced age and stage \u003cem\u003e(Figure 4-5).\u003c/em\u003e The relation between ECOG and complications are at the limits of statistical significance \u003cem\u003e(p value 0,061 and 0,063 respectively).\u0026nbsp;\u003c/em\u003eNo significant associations were found between survival, sex, repiratory function, levels of creatinine and potassium in the blood, dialysis duration and CCI.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present work is a multicenter retrospective observational study that focuses on the outcomes of lung surgery for cancer performed on hemodialysis patients.\u003c/p\u003e\u003cp\u003ePostoperative complication rate was 84%, 26% of which for hemmorhage and 21% iperkalemia. Regarding complications in other studies, these vary from 27\u0026ndash;100%. A deitailed analysis shows that complications most frequently in other studiese are: pnemonia [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], atrial fibrillation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], iperkalemia [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and bronchial obstruction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe use of blood transfusion was necessary in 47% of cases and 68% of patients had a drop in preoperative hemoglobin values. The association between the two events was statisticallly significant, thus implying the need for careful monitoring of hemoglobin values and eventually the preoperative use of erythropoiesis stimulating agents or iron, according to international guidelines. Furthermore, having found the association between transfusion and risk of complications, it would be amenable to reduce the use of this practice.\u003c/p\u003e\u003cp\u003eMany studies have recorded the frequent use of nafamostat mesilato (drug used in Japan) as anticoagulant during dialysis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In contrast to heparin, it prolongs clotting time only in extracorporeal circuit; it is used in Japan in patients at high risk of bleeding. In contrast, Tomizawa e Watanabe [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], consideringthe absence of bleeding with the use of heparin, they believe that this drug can be used safely. According to data reported by Ciriaco [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], the bleeding risk is minimized by reducing the heparin dosage. In Tsuchida\u0026rsquo;s study [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] the use of antiplatelets an anticoagulants drugs did not affected bleeding.\u003c/p\u003e\u003cp\u003ePerioperative management involves careful monitoring hydoelectrolyte balance. In this regard, many authors consider it is useful monitoring with central venous catheter and an arterial catheter [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Ciriaco [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] demonstrated that preoperative dialisys performed two consecutive days before surgery and the day after surgery reduced the extent of hydrolytic imbalances. According to the date reported by Watanabe [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], in our study 89% of patients (17/19) performed the last dialysis session the day before surgery. First hemodialysis session was performed in 10 cases on day after surgery and in 5 cases two days after surgery. Emergency dialysis was necessary in 6 patients, in 5 patients due to excessively high level of potassium and in one case due to acute pulmonary edema.\u003c/p\u003e\u003cp\u003eMorita [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] reported association between postoperative potassium level and the increase in creatinphosphokinase values (CPK) and the extension of muscle resection. Since video thoracoscopy requires less muscle resection than thoracotomy, it is believed that this may be advantageous in reducing potassium levels [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Obuchi [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] compared population undergoing thoracotomy vs videothoracoscopy: no statistically significant differences were found in this study regarding duration of surgery, bleeding, duration of drainage and length of hospital stay. In our case stady, such comparison was not possible due to the small number of patients undergoing minimally invasive surgery.\u003c/p\u003e\u003cp\u003eIn this study the risk of complications was associate to smoke. Both the incidence of complications and hospital stay were significantly higher than the general population (average 17 days, median 11 days). Hospitalization was associated to duration of preoperative dialysis according to an inverse correlation. This probably is due to the fact that these patients require a longer period of adaptation, therefore a longer period of hospitalization; instead those on dialysis for the longest time have already achieved a good balance, therefore the duration of hospitalization is not affected significantly by dialysis. From the analysis of the literature, the correlation between smoke and complications is confirmed by Watanabe [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], who also identifies an association with the duration of surgery. Yamamoto [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] identifies as a risk factor for complications large lung resections and hystory of stroke. In this study we don\u0026rsquo;t found association between type of surgery and complications. Furthermore in our case sudy there is only one patient with history of ictus, died after surgery; he had severe vasculopaty and arterial hypertension. Other authors note a greater risk of complications subjects with cardiovascular comorbidities or reduced respiratory function [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Tomizawa [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] identifies an association between complications and CCI; also he highlights the risk of exacerbation of interstitial pulmonary disease is greater in dialysis patients than general population (50% vs 9,3%) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this case study the postoperative mortality rate (30 days after surgery) is 5%, because one patient died 27 days after surgery. Table\u0026nbsp;\u003cspan refid=\"Tab13\" class=\"InternalRef\"\u003e13\u003c/span\u003e shows the results of the studies, in the last twenty years, about hemodialysis patients undergoing to surgery for lung cancer, excluded case reports.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab13\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 13\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAutore\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnno di pubblicazione\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumero di pazienti\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u0026deg; pazienti in stadio Ia (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMorbilit\u0026agrave; %\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMortalit\u0026agrave; %\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOS 5 anni %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMorita et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTsuchida et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCiriaco et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObuchi et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTakahama et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObuchi et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuehir et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMatsuoka et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePark et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOtsuki et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTomizawa et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYamamoto et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27 (69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWatanabe et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresente studio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eStudy results on hemodialysis patients undergoing resection for lung cancer.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFrom data present in the literature, it is note that postoperative mortality rate varies from 0 to 14%, therefore, our date is placed in the first half of the distribution. In-hospital mortality was remarkable (10,5%), but not higher than that previously reported in other studies. Postoperative mortality in hemodialysis patients is higher than general population: 6% for pneumonectomy, 3% for lobectomy and less than 1% for wedge resections [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs for long term results, OS at 3 and 5 years was respectively 46% and 29%. In other studies 5 years OS varies from 25\u0026ndash;60%, therefore our data is in the average of that reported in literature.\u003c/p\u003e\u003cp\u003e According to data from SEER (Surveillance, Epidemiology and End Results del National Cancer Institute), 5 years OS for lung cancer is 26,7%. Considering survival by stage, 5 years OS is 63,7% for early-stage, 35,9% for involvement of regional lymph node; 8,9% for metastatic tumors; 15,6% for unstaged forms [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. So if we consider that patient scheduled for sugery have early-stage tumors, OS of 29% is lower than OS of general population (59,8%). However in our study there were also some stage III patients which may have worsened overall survival. Furthermore, it must be considered mortality due to causes other than cancer which is also high in other studies. Table\u0026nbsp;\u003cspan refid=\"Tab14\" class=\"InternalRef\"\u003e14\u003c/span\u003e reports, for each published study, the number of deaths from causes other than cancer: the total number of deaths was 79, of which 63% were non cancer-related, witnessing the impact of chronic renal failure and comorbidities on survival. Indeed, according to Japanese\u0026rsquo;s report of Society of Dialysis Therapy, survival of dialysis patients is 61% at 5 years, 37% at 10 years and 23% at 15 years [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]; while, according to date of Italian society of nephrology, annual mortality is 17% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab14\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 14\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAutore\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAnno di pubblicazione\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumero\u003c/p\u003e\u003cp\u003edi pazienti\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN\u0026deg; morti\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN\u0026deg; morti\u003c/p\u003e\u003cp\u003eper cancro\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eN\u0026deg; di morti per altro\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e% N\u0026deg; di morti per altro\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMorita et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTsuchida et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCiriaco et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObuchi et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTakahama et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObuchi et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuehir et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMatsuoka et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePark et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOtsuki et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTomizawa et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYamamoto et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWatanabe et al.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eND\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresente studio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eCauses of death in hemodialysis patients undergoing lung surgery for cancer\u003c/h2\u003e\u003cp\u003eTherefore, while the data on OS seem disappointing, the data on DFS are more comforting. Out of 14 dead patients, only 4 showed disease recurrence and only 2 dead from cancer. DFS is definitely higher: 77% at 3 years 62% at 5 years. Also Yamamoto [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] reports similar data on DFS: 66,5% for stage Ia and 52,9% for othe stages at 5 years.\u003c/p\u003e\u003cp\u003eIn this study, the analysis of survival curves highlighted that survival is adversely affected by advanced age and stage. These correlations have been extensively studied in literature, so it isn\u0026rsquo;t surprising that in our analysis resulted significant. The survival was not affected by type of surgery instead, this leading to reflection that major resections should not be denied in properly selected patients (young and with early-stage disease). An interesting fact is that during of dialysis does not influence survival or complications.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe limitations of this work are: retrospective study and small sample size. Furthermore, the data collection is spread over twenty years, therefore it isn\u0026rsquo;t considered progress in recent years about surgical techiques with the introduction of new technoligies, improvements in dialysis technique and in chronic management of dialisys patient resultingin increased survival. Despite the limitations considered, a significant fact is certainly the association between smoke and complications, therefore smokers are considered at risk. Furthermore, results regarding bleeding indicate to pay attention to the management of these aspects, both preoperatively and postoperatively.\u003c/p\u003e\u003cp\u003eThe results of the present study, in particular those about OS and DFS, demonstrates that surgery for lung cancer is a reliable therapeutic option in patients with end-stage chronic renal failure: accurate patients selection and careful perioperative management are mandatory to minimize complications since most of patients die from non cancer-related events.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOS (5-years overall survival); DFS (5-years Disease free survival); FEV1 (Forced Expiratory Volume in 1 second); DLCO (Diffusing capacity of the lungs for carbon monoxide); FE (Ejection Fraction); CCI (Charlson Comorbidity Index); ECOG (Eastern Cooperative Oncology Group); COPD (Chronic Obstructuve Pulmonary Disease); CPK (creatinphosphokinase values); SEER (Surveillance, Epidemiology and End Results del National Cancer Institute).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCOMPETING INTERESTS\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFUNDING\u003c/h2\u003e\u003cp\u003eNo funding available for this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE. C.,C. R., CB wrote the main manuscript text. C.R. prepared figures. D.B., A.S., P.F. contributed to the data collection.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank all of doctors who operate in the partecipating centers and who have contribuited to the database. This study was partially supported by Italian Ministry of Health \u0026ndash; Ricerca Corrente Annual Program 2026.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eECOG PERFORMANCE STATUS As published in Am. J. Clin. Oncol.: Oken, M.M., Creech, R.H., Tormey, D.C., Horton, J., Davis, T.E., et al.: Toxicity And Response Criteria Of The Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649-655, 1982.\u003c/li\u003e\n\u003cli\u003eM E Charlson, P Pompei, K L Ales, C R MacKenzie. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83\u003c/li\u003e\n\u003cli\u003eDaniel Dindo , Nicolas Demartines, Pierre-Alain Clavien. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13.\u003c/li\u003e\n\u003cli\u003eTsuchida M, Yamato Y, Aoki T et al. Complications associated with pulmonary ung resection in lung cancer patients on dialysis. Ann Thorac Surg 2001;71:435-8\u003c/li\u003e\n\u003cli\u003eCiriaco P, Casiraghi M, Melloni G et al. Pulmonary resection for non-small-cell lung cancer in patients on hemodialysis: clinical putcome and long-term results. World J Surg 2005;29.1515-19.\u003c/li\u003e\n\u003cli\u003eTakahama M, Yamamoto R, Nakajima R et al. Pulmonary resection for lung cancer patients on chronic hemodialysis: clinical outcomes and long-term results after operation. Interact cardiovasc thorac surg 2010;11:150-3.\u003c/li\u003e\n\u003cli\u003eObuchi T, Imakiire T, Nakashina H et al. Video-assisted thoracic surgery for lung cancer in hemodialysis patients. Asian J Endosc Surg 2011;4:157-60\u003c/li\u003e\n\u003cli\u003eMatsuoka K, Kuroda A, Kang A et al. Video-assisted thoracoscopic surgery for lung cancer in patients on hemodialysis. Ann Thorac Cardiovasc Surg 2013;19:263-7\u003c/li\u003e\n\u003cli\u003ePark BJ, Shin S, Kim HK et al. Surgical treatment for non-small cell lung cancer in patients on hemodialysis due to chronic kidnely disease: clinical outcome and intermediate-term results. Korean J Thorac Cardiovasc Surg 2015;48:193-8.\u003c/li\u003e\n\u003cli\u003eOtsuki Y, Kuwahara H, Konn H. Outcomes, safety and feasibility of video-assisted thoracic surgery in lung cancer patients on hemodialysis: a case series. Gen Thorac Cardiovasc Surg 2018:66-48-53\u003c/li\u003e\n\u003cli\u003eTomizawa K, Sato K, Ohara S et al. Life-threatening complications after pulmonary resection for lung cancer in patients on chronic hemodilaysis. Surg today 2019;49:513-20.\u003c/li\u003e\n\u003cli\u003eYamamoto Y, Kanzaki R, Ose N et al. Lung cancer surgery for patients on hemodialysis: a decade of experience at a multicenter institutions. Ann Thorac Surg 2020;109:1558-65.\u003c/li\u003e\n\u003cli\u003eWatanabe Y, Hattori A, Fukui M et al. Postoperative complications and perioperative management in patients on hemodialysis undergoing lung resection. Gen Thorac Cardiovasc Surg, 2020, September 28. DOI:10.1007/s11748-020.01489-x.\u003c/li\u003e\n\u003cli\u003eKoichi Suehiro and Ryu Okut. Perioperative Complications in Patients with End-Stage Renal Disease Undergoing Pulmonary Resection. Suehiro and Okutani J Anesthe Clinic Res 2011, 2:3\u003c/li\u003e\n\u003cli\u003eObuchi T, Hamanaka W, Yoshida Y, et al. Clinical outcome after pulmonary resection for lung cancer patients on hemodialysis. Ann Thorac Surg.2009 \u003c/li\u003e\n\u003cli\u003eMorita T, Tachibana S, Kawakami M, et al. Pulmonary lobectomy for lung cancer in patients on chronic hemodialysis. Jpn J Chest Surg 2001; 15: 454-8. (in Japanese)\u003c/li\u003e\n\u003cli\u003eSato T, Teramukai S, Kondo H, Watanabe A, Ebina M, et al. Impact and predictors of acute exacerbation of interstizial lung diseases after pulmonary resection for lung cance. J Thoracic Cardiovasc Surg. 2014;147:1604-11.\u003c/li\u003e\n\u003cli\u003eWatanabe S, Asamura H, Suzuki K et al. Recent results of post operative mortality for surgical resection in lung cancer. Ann Thor Surg 2004;78:999-1003.\u003c/li\u003e\n\u003cli\u003ehttps://seer.cancer.gov/statfacts/html/lungb.html\u003c/li\u003e\n\u003cli\u003ehttps://ridt.sinitaly.org/category/registro-nazionale\u003c/li\u003e\n\u003cli\u003eThe Japanese Society of Dialysis Therapy (JSDT). About JSDT. Available at: https://docs.jsdt.or.jp/overview/. Accessed: January 20, 2020.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"hemodialysis, lung cancer, end-stage renal disease, pulmonary resection","lastPublishedDoi":"10.21203/rs.3.rs-6680380/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6680380/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe end-stage renal disease is arising worldwide, but there are few reports about pulmonary resection in hemodialysis patients with lung cancer. The objective of the authors is to assess lung cancer surgery outcomes in patients undergoing hemodialisys, to identify the risk factors for morbidity, mortality and overall survival.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eClinical records data of 19 hemodialysis patients undergoing curative surgery for lung cancer in 3 centers between 2001 and 2021 were retrospectively collected and analyzed. There were considered pre-operative and perioperative variables and their relationship with morbidity, mortality and survival.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe complication rate was 84%, with a mortality rate of 5%. The most common complication was bleeding. Heavier smoking history was associated to higher risk of developing complications. Also transfusions were associated with complications. The 5-years overall survival (OS) rate was 29%, while the 5-years Disease free survival (DFS) rate was 62%. OS was correlated with age and clinical stage. Most patients showed non cancer-related deaths.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eIn conclusion, although the mortality is remarkable in patients in hemodialisys, the data about OS and DFS make us believe that lung surgery may be still a therapeutic option if patients are properly selected and careful perioperative management is performed.\u003c/p\u003e","manuscriptTitle":"The Outcome of Lung Cancer Surgery in Patients on Chronic Hemodialysis: A Multicenter Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 13:29:17","doi":"10.21203/rs.3.rs-6680380/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb6bee2e-c8fb-411e-8bc8-0c39b82c687f","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54421226,"name":"Biological sciences/Cancer"},{"id":54421227,"name":"Health sciences/Diseases"},{"id":54421228,"name":"Health sciences/Health care"},{"id":54421229,"name":"Health sciences/Medical research"},{"id":54421230,"name":"Health sciences/Nephrology"},{"id":54421231,"name":"Health sciences/Oncology"},{"id":54421232,"name":"Health sciences/Risk factors"},{"id":54421233,"name":"Health sciences/Signs and symptoms"}],"tags":[],"updatedAt":"2025-09-17T02:38:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 13:29:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6680380","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6680380","identity":"rs-6680380","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}