Surgery for lung adenocarcinoma with smokers’ polycythemia: a case report

BMC Research Notes

Shizuka Kaseda²  Naoya Nakamura³  Hiromi Shinoda¹  Etsuo Nemoto²  Yasoo Sugiura² 

[1] Isehara Kyodo Hospital, Respiratory Medicine, 2-17-1 Sakuradai, Isehara, Kanagawa, 259-1132, Japan;National Hospital Organization, Kanagawa National Hospital, Pulmonary and Thoracic Surgery, 666-1 Ochiai, Hadano, Kanagawa, 257-8585, Japan;Tokai University Hospital, Division of Pathology, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan

关键词: Lung lobectomy;    Lung cancer;    Predictive hematocrit;    Phlebotomy;    Smokers’ polycythemia;   

Others  :  1144867
DOI  :  10.1186/1756-0500-6-38

 received in 2012-08-01, accepted in 2013-01-30,  发布年份 2013

【 摘 要 】

Background

Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers’ polycythemia has never been reported. We herein report a patient with lung cancer and smokers’ polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period.

Case presentation

A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA). When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×10⁶/μL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists’ diagnosis was secondary polycythemia due to heavy smoking (smokers’ polycythemia) because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at <50% postoperatively, and the patient was uneventfully discharged on postoperative day 7. The predictive hematocrit and measured hematocrit were very closely approximated in this case.

Conclusion

We experienced a patient with smokers’ polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.

【 授权许可】

   
2013 Sugiura et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Steliga MA, Dresler CM: Epidemiology of lung cancer: smoking, secondhand smoke, and genetics. Surg Oncol Clin N Am 2011, 20:605-618.
• [2]Smith JR, Landaw SA: Smokers' polycythemia. N Engl J Med 1978, 298:6-10.
• [3]Marchioli R, Finazzi G, Landolfi R, Kutti J, Gisslinger H, Patrono C, Marilus R, Villegas A, Tognoni G, Barbui T: Vascular and neoplastic risk in a large cohort of patients with polycythemia vera. J Clin Oncol 2005, 23:2224-2232.
• [4]Pearson TC, Messinezy M: The diagnostic criteria of polycythaemia rubra vera. Leuk Lymphoma 1996, 22(Suppl 1):87-93.
• [5]McMullin MF, Bareford D, Campbell P, Green AR, Harrison C, Hunt B, Oscier D, Polkey MI, Reilly JT, Rosenthal E, Ryan K, Pearson TC, Wilkins B, General Haematology Task Force of the British Committee for Standards in H: Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis. Br J Haematol 2005, 130:174-195.
• [6]Spiers AS, Levine M: Smokers' polycythaemia. Lancet 1983, 1:120.
• [7]Landaw SA: Polycythemia vera and other polycythemic states. Clin Lab Med 1990, 10:857-871.
• [8]Marchioli R, Finazzi G, Specchia G, Masciulli A, Mennitto MR, Barbui T: The CYTO-PV: A large-scale trial testing the intensity of CYTOreductive therapy to prevent cardiovascular events in patients with polycythemia vera. Thrombosis 2011, 2011:794240.
• [9]Tefferi A: Polycythemia vera and essential thrombocythemia: 2012 update on diagnosis, risk stratification, and management. Am J Hematol 2012, 87:285-293.
• [10]Wasserman LR, Berk PD, Berlin NI: Treatment of polycythemia vera: a summary of clinical trials conducted by the Polycythemia Vera Study Group. In Polycythemia vera and the myeloproliferative disorders. Edited by Wasserman LR, Berk PD, Berlin NI. Philadelphia: WB Saunders; 1995:166.
• [11]Raval M, Paul A: Cerebral Venous Thrombosis and Venous Infarction: Case Report of a Rare Initial Presentation of Smoker's Polycythemia. Case Rep Neurol 2010, 2:150-156.
• [12]De Stefano V, Za T, Rossi E, Vannucchi AM, Ruggeri M, Elli E, Mico C, Tieghi A, Cacciola RR, Santoro C, Gerli G, Vianelli N, Guglielmelli P, Pieri L, Scognamiglio F, Rodeghiero F, Pogliani EM, Finazzi G, Gugliotta L, Marchioli R, Leone G, Barbui T, Party GC-W: Recurrent thrombosis in patients with polycythemia vera and essential thrombocythemia: incidence, risk factors, and effect of treatments. Haematologica 2008, 93:372-380.
• [13]Newton LK: Neurologic complications of polycythemia and their impact on therapy. Oncology (Williston Park) 1990, 4:59-64. discussion 64–56
• [14]Di Nisio M, Barbui T, Di Gennaro L, Borrelli G, Finazzi G, Landolfi R, Leone G, Marfisi R, Porreca E, Ruggeri M, Rutjes AW, Tognoni G, Vannucchi AM, Marchioli R, European Collaboration on Low-dose Aspirin in Polycythemia Vera I: The haematocrit and platelet target in polycythemia vera. Br J Haematol 2007, 136:249-259.
• [15]Thakur KT, Westover MB: Cerebral infarction due to smoker's polycythemia. BMJ Case Rep 2011.
• [16]Pearson TC, Guthrie DL, Simpson J, Chinn S, Barosi G, Ferrant A, Lewis SM, Najean Y: Interpretation of measured red cell mass and plasma volume in adults: Expert Panel on Radionuclides of the International Council for Standardization in Haematology. Br J Haematol 1995, 89:748-756.
• [17]Yeager MP, Spence BC: Perioperative fluid management: current consensus and controversies. Semin Dial 2006, 19:472-479.
• [18]Fujioka S: Formula for a prediction of venous hematocrit value following phlebotomy and infusion in polycythemia vera. Med Biol 1988, 117:247-249.
• [19]Weinberg I, Borohovitz A, Krichevsky S, Perlman R, Ben-Yehuda A, Ben-Yehuda D: Janus kinase V617F mutation in cigarette smokers. Am J Hematol 2012, 87:5-8.