Torakochirurgia
Total serum protein deviation in patients treated by pneumonectomy due to non-small cell lung cancer

Aim:
To evaluate changes in total serum protein level and colloid osmotic pressure in patients after pneumonectomy in the perioperative period.

Materials and methods:
41 patients (32 male, age 43-72, mean 57.8; and 9 female, age 45-73, mean 58.1) with non-small cell lung cancer qualified for surgical treatment before and 1, 2, 4 and 7 days after pneumonectomy were examined.
Duration of surgery, stage of tumour development and other parameters such as RBC, WBC, and HCT were recorded. Only patients with no weight loss or other emaciation symptoms, with no chronic renal/liver disease and without reduced production or interference of proteins were included in this study in order to eliminate possible metabolic disorders before the operation.

Results:
23 patients underwent left-sided pneumonectomy,
18 right-sided. In 18 patients arterial vasculature of the lung was ligated first and in 23 pts venous return was ligated. Duration of surgery ranged from 85 to 220 minutes (mean 134). All patients underwent mediastinal lymphadenectomy, 12 patients received chemotherapy before the surgery, and 29 patients were qualified for surgery without neoadjuvant treatment. Histologically squamous epithelial carcinoma predominated, which was diagnosed in 25 patients; 7 patients had macrocellular carcinoma, 5 adenocarcinoma, 2 combined form – one patient with small-cell cancer and typical carcinoid tumour.
Gradual decrease of total protein serum level was observed 24 hours and 48 hours after surgery, then a slow increase on the 4th and 7th day after surgery, regardless of other examined parameters. A statistically significant decrease was observed in protein level before and on each day after the operation as well as on POD#1 vs. POD#7 day (p<0.02) and POD#2 vs. POD#7 day (p<0.02) and POD# 2nd vs. POD#. 7th (p<0.04).
There was no statistically significant correlation between changes in total protein level and any other parameters.

Conclusion:
Changes of total serum protein level in the early postoperative period after pneumonectomy are significant and require careful monitoring.