Unilateral pulmonary artery pre-operative occlusion test: technical feasibility and safety prior to pneumonectomy or pleuropneumonectomy for malignancy

Our plain-English summary of Unilateral pulmonary artery pre-operative occlusion test: technical feasibility and safety prior to pneumonectomy or pleuropneumonectomy for malignancy, by M. Shimohira, T. Hashizume, K. Ohta, et al (The British Journal of Radiology, 2018).

The study

• Authors: M. Shimohira, T. Hashizume, K. Ohta, K. Suzuki, M. Nakagawa, Y. Ozawa, K. Okuda, S. Moriyama, R. Nakanishi, Y. Shibamoto
• Journal: The British Journal of Radiology
• Published: 2018;91(1083):20160775
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: The aim of the present study was to assess the technical feasibility and safety of the unilateral pulmonary artery occlusion (UPAO) test in pre-operative evaluation of pneumonectomy or pleuropneumonectomy for lung or pleural tumours.

Methods: The UPAO test was performed on 91 patients who were scheduled to undergo or were being considered for pneumonectomy or pleuropneumonectomy between June 2003 and July 2016. There were 74 males and 17 females, with a median age of 65 years (range, 23-80). The technical success rate, procedure time and complication rate were evaluated. Technical success was defined as completion of the UPAO test.

Results: The diagnoses of the 91 patients were as follows: lung cancer in 63, malignant pleural mesothelioma in 21, thymoma in 5, lung metastasis in 1 and lung carcinoid in 1. The UPAO test was performed successfully on 88 out of 91 patients (technical success rate: 97%). The median procedure time was 57 min (range, 34-120). Cardiac arrest due to migration of the balloon catheter to the pulmonary trunk occurred in 1 patient (complication rate: 1.1%).

Conclusion: The UPAO test in pre-operative evaluation of pneumonectomy or pleuropneumonectomy for lung or pleural tumours appears to be technically feasible. However, it needs to be performed with care in order to avoid severe complications. Advances in knowledge: The UPAO test can be safely performed and is helpful in evaluating patients for pneumonectomy or pleuropneumonectomy.

In plain English

This short communication from Japan looked back at 91 patients (74 men and 17 women, median age 65) who had a pre-surgery test called the unilateral pulmonary artery occlusion (UPAO) test between June 2003 and July 2016. The test briefly blocks the artery to one lung with a balloon. It checks whether the heart and lungs could cope with pneumonectomy or pleuropneumonectomy, operations that remove a lung. Of the 91 patients, 63 had lung cancer and 21 had malignant pleural mesothelioma. The article does not discuss asbestos. The test was completed in 88 of 91 patients (97%), with a median time of 57 minutes. One patient (1.1%) had a cardiac arrest when the balloon moved into the pulmonary trunk. The heart beat recovered on its own once the balloon was deflated. Of 53 patients who passed the test and then had surgery, 52 had no cardiopulmonary complications during a median follow-up of 29 months. One developed pulmonary hypertension 70 months later. The authors concluded the test is a useful additional investigation that needs careful technique. They noted that follow-up was relatively short for some patients.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-institution study of a pre-operative procedure, published as a short communication
• Who was studied: All 91 patients (74 males, 17 females, median age 65, range 23–80) at Nagoya City University, Japan, who were scheduled for or being considered for pneumonectomy or pleuropneumonectomy between June 2003 and July 2016. Diagnoses: lung cancer 63, malignant pleural mesothelioma 21, thymoma 5, lung metastasis 1, lung carcinoid 1.
• Exposure: No asbestos or other environmental or occupational exposure was studied. The study evaluated a medical procedure: the UPAO test, in which a balloon catheter temporarily blocks the pulmonary artery on the side of planned surgery and pulmonary artery pressure is measured. The article does not mention asbestos.
• Main results:
  • The UPAO test was completed in 88 of 91 patients (technical success rate 97%). In the other 3, it was stopped because of difficulty advancing the catheter (2 patients) or procedure-related cardiac arrest (1 patient).
  • The median procedure time was 57 minutes (range 34–120).
  • Cardiac arrest occurred in one patient having the test for left lung cancer (complication rate 1.1%). It was caused by the balloon catheter migrating to the pulmonary trunk. The balloon was deflated immediately and the heart beat recovered spontaneously.
  • In the 88 completed tests, the median mean pulmonary artery pressure after 15 minutes was 20 mmHg (range 12–42). It was below 30 mmHg in 79 of 88 patients. In the remaining nine it was 30–42 mmHg (median 31).
  • Of 53 patients who passed the test and underwent pneumonectomy (34) or pleuropneumonectomy (19), 52 (98%) had no cardiopulmonary complications during a median follow-up of 29 months (range 1–160). One patient, whose 15-minute mean pressure had been 23 mmHg, was diagnosed with pulmonary hypertension 70 months after pneumonectomy (1 of 53, 1.9%) and died of arrhythmia the next day after the examination.
  • Pneumonectomy or pleuropneumonectomy was avoided in the nine patients with mean pressure of 30 mmHg or higher. Seven had lobectomy or segmental resection and two received chemotherapy and/or radiation. Those who had lobectomy or segmental resection had no cardiopulmonary complications during a median follow-up of 22 months (range 2–133).
• The authors' conclusion: The authors concluded that the UPAO test is a useful additional investigation to consider before pneumonectomy or pleuropneumonectomy for lung or pleural tumours, that it has a high technical success rate, and that careful technique is needed to avoid major complications. They also stated that the test does not definitely predict the absence of pulmonary hypertension after surgery.
• Limitations the authors state:
  • Follow-up was relatively short for some patients.
  • The test does not definitely predict the absence of pulmonary hypertension after surgery; one patient who passed the test later developed it.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Pneumonectomy, Lung Cancer, Pleural Mesothelioma, Metastasis.

Related studies

• Ultrasound-guided pneumothorax induction prior to local anaesthetic thoracoscopy — J.P. Corcoran, I. Psallidas, et al. (2015)
• Mesothelioma and internal carotid artery occlusion: acute ischemic stroke and efficacy of emergency carotid thrombectomy — E. Ferrero, M. Ferri, et al. (2010)
• Mentored experience of establishing a national peritoneal malignancy programme - Experience of first 50 operative cases — K.H. Chang, M. Kazanowski, et al. (2017)
• Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study — T. Treasure, L. Lang-Lazdunski, et al. (2011)
• Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery — T. Tokunaga, N. Sawabata, et al. (2010)
• Feasibility and safety of outpatient medical thoracoscopy at a large tertiary medical center: a collaborative medical-surgical initiative — Z.S. DePew, D. Wigle, et al. (2014)

Browse more research in The British Journal of Radiology, or return to medical research.