- Massive bleeding due to injury of the major vessels, particularly caused by tumor infiltration or inflammatory adherent lymph nodes
- Through compression using a swab, the situation can usually be controlled to the extent that, under continuous compression, the transition to thoracotomy can be managed in a controlled manner without excessive blood loss, enabling the anesthesia team to be informed, further instruments to be prepared, and, if necessary, adequate assistance to be organized. Blind clamping and suturing attempts generally exacerbate the damage.
- Parenchymal lesions of the lung during mobilization or in the area of staple lines, especially with obliterated interlobar fissure
- An attempt at suturing is often futile in vulnerable lung tissue or emphysematous lung. Here, the use of staple line reinforcement or a sealing matrix is helpful.
- In individual cases, the surgeon must decide, based on information from anesthesia, about the fistula volume, whether conservative therapy with chest drainage is also justifiable.
- Injury to the contralateral pleura
- Particularly during the preparation of infracarinal lymph nodes at station 7, unnoticed opening of the contralateral mediastinal pleura can lead to tension pneumothorax. It is important to recognize the situation and either open the pleura widely or insert a chest drain on the opposite side.
- Injury to the tracheal wall, main bronchi, or other segmental bronchi
- Injury to the vagus nerve, phrenic nerve, and recurrent laryngeal nerve
- Injury to the esophagus
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Intraoperative Complications
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Postoperative complications
- Cardiac arrhythmia (10-15%)
- Lobe torsion (0.1-0.3%)
- In case of suspicion, immediate confirmation of diagnosis using CT imaging and surgical revision. If the rotated lobe still appears viable, a subpleural fixation suture to the adjacent lobe is possible. In cases of unclear viability or gangrene, the affected lobe must be removed.
- Postoperative anastomotic insufficiency (2-8%)
- Early symptoms can include high fistula volumes, respiratory or cardiac decompensation, with purulent sputum and fever occurring later. Early confirmation of diagnosis using bronchoscopy is crucial for prognosis and progression.
- Covering the anastomosis in high-risk patients (neoadjuvant pre-treatment, diabetes mellitus, ipsilateral previous surgery) with a pericardial fat pad or muscle flap is recommended.
- The treatment is usually surgical revision.
- Anastomotic stenosis (3-9%)
- Persistent air fistula (from the 8th postoperative day, approximately 8-15%)
- A revision surgery due to a parenchymal fistula is very rarely required. Conservative therapy (with patience, suction release attempt, or chemical pleurodesis) is often sufficient.
- Postoperative pleural empyema (0.1-2%)
- The most common cause is a persistent air fistula with contamination of the pleural cavity in the presence of a pre-existing immune deficiency.
- The initial treatment consists of adequate drainage and antibiotic therapy. Surgical revision is often necessary in the case of a persistent bronchopleural fistula.
- Key measures include rapid initiation of therapy with broad-spectrum antibiotics, bronchial hygiene, and bronchoscopic material collection (microbiology), as well as intensive physiotherapy.
- Hemothorax (requiring transfusion or re-operation 1-4%)
- Immediate surgical revision is required for 1L of bloody secretion in the first hour post-operation or persistent output of 200-400ml/h in the first 5 hours post-operation.
- Chylothorax (0.5-1%)
- Initially, conservative therapy with MCT diet or parenteral nutrition. If secretion persists for over 14 days, radiological intervention or surgery is indicated.
- Vocal cord paralysis (0-1%)
- Speech therapy and ENT co-management.
- Nerve lesions due to positioning injuries