Management of Massive Hemoptysis: A Single Institution Experience

Introduction: Definition of massive hemoptysis is unclear: criteria range from 100cc /day to 1000cc over a few days. Massive hemoptysis is seen in 1.5 % of all hemoptysis cases. Deaths occurring by exsanguination or asphyxiation from flooding of the alveoli with blood and intractable hypoxemia. The 3 principles of management of hemoptysis consist: 1) maintain airway patency and oxygenation, 2) localize the source of bleeding, 3) control hemorrhage. Consider surgery for lateralized uncontrollable massive hemoptysis unresponsive to other measures or as a definitive therapy in patients whose hemoptysis and general medical condition have stabilized. Objective: Analyses of our experience in treatment of 24 patients with severe hemoptysis for in single thoracic surgery Unit in SU”Shefqet Ndroqi” Tirana, Albania. Material and Methods: In a 5-year period 2009-2013, twenty-four patients were admitted in our hospital with massive hemoptysis. All patients are estimated by: Physical examination, CXR, CT Chest, Bronchoscopy and Arteriography. Fifteen 15 (62%) patients received surgical resection as a definitive therapy. Results: Of twenty-four patients enrolling in the study 18 were males and 6 females, mean age 54.9±13,7 years. The underlying pathology included bronchiectasis (n=5), active tuberculosis (n=9), pneumomycosis (n=7), lung cancer (n=2) and pulmonaryhydatic cyst(n=1). Hemoptysis ceased with conservative management in 9 patients (38%) only. Fifteen 15 (62%) patients received surgical resection. The procedures included lobectomy (n=13), bilobectomy (n=1) and pneumonectomy (n=1). The in-hospital mortality after surgery was 4.1% (1) patient. Redu-thoracotomy and right axillary open window in one patient. Postoperative morbidity occurred in 4 patients, including prolonged ventilatory support, bronchopleural fistulae, empyema and myocardial infarction. Conclusions: The clinical outcome for massive hemoptysis reflects the generalized nature of a destructive disease process involving both lungs and a limited respiratory reserve. Surgery is associated with high risk of morbidity and mortality, and should be performed only in selected patients.Keywords: masive Hemoptysis, Chest, Bronchoscopy and Arteriography, bronchopleural fistulae, empyema and myocardial infarction

Early and Late Outcome, Mortality and Major Morbidity After Lung Cancer Surgery for Primary Carcinoma

Background: Radical surgical resection of lung cancer with or without adjuvant treatment is still a prerequisitefor cure. Advances in operative and postoperative care led to a decline in complications and mortality rates during the last decades. In spite of different additional modes of treatment, survival is still poor. The aim of study: To examine the operative mortality and morbidity after lung cancer surgery and to identify factors associated with an adverse outcome. Material and methods: The study comprised 968 consecutive patients referred to University Hospital of Lung Disease, “Shefqet Ndroqi” Tirana, Albania, for lung carcinoma, during a 13-years period (January 2004-December 2017). All patients underwent routine laboratory examinations spirometry and preoperative CT- scan of the thorax and upper abdomen. PET-CT, EBUS–EUS, Mediastinotomy or Mediastinoscopy wasn’t performed as routine. Results: Of 968 patients, 690 (70.5%) were male and 278 (28.7%) female. Mean age 65.5±9.4 years (range 15 - 87 years). Lobectomy was the most used surgical modality in 566 (58.5%) patients, meanwhile pneumonectomy was performed in 112 (11.6%) of patients. Minor complications during surgery occurred in 45 (11.7%) ofpatients. Continuous air leakage was the most complication after surgery in 25.3%, followed by lung atelectasis in 21.3% and cardiovascular complications in 17%. Conclusion: our results show low mortality and morbidity after lung cancer surgery. However, patients with reduced lung capacity, older age and those undergoing pneumonectomy should be treated with great care