Pulmonary thromboembolism in patients after surgery for pulmonary malignant tumor

From January 1994 to December 2004, 6 of 1,034 patients (0.58%) with pulmonary malignant tumor developed pulmonary thromboembolism (PTE) after surgery in our department. Five of 6 patients had primary lung cancer, and 1 had metastatic lung tumor. The surgeries for the 6 patients contain 1 exploration thoracotomy, 1 wedge resection, 3 lobectomies, and 1 pneumonectomy. The length of time between operation and making diagnosis of PTE was 2-7 days. All 6 patients initially showed symptoms of desaturation and tachycardia. Chest computed tomography (CT) was the most useful diagnostic method. In all cases, we started intravenous administration of unfractionated heparin sodium immediately after making diagnosis. In 2 cases, we needed to add thrombolysis by urokinase because of their serious condition. One patient in whom the establishment of diagnosis took longer time died on the postoperative day 9, in spite of the removal of the thrombus by percutaneous approach. The other 5 patients made a recovery and observed no signs of recurrence of PTE after 6-month anticoagulant therapy by warfarin potassium. PTE can be treated only with anticoagulant therapy if we confirm the diagnosis and start the treatment immediately after the first episode.