title: Urgent pulmonary lobectomy for blunt chest trauma: report of three cases without mortality.
abstract: BACKGROUND
  The majority of patients with severe blunt chest trauma is successfully treated with supportive measures and thoracostomy tube; only few cases need urgent thoracotomy. Lung-sparing techniques are treatments of choice but major pulmonary resections are necessary in case of injuries involving hilar vessels or bronchi. Currently the mortality associated with pulmonary lobectomy performed for chest trauma is 40%.
  
  
  METHODS
  Over a 2-year period [2013-2014], 210 patients with chest trauma were hospitalized at our Institution. Mechanism of injury was blunt in 204 (97.1%) patients and penetrating in 6 (2.9%). In 48 (22.8%) patients was necessary a ventilatory support and 37 (17.6%) patients were treated with thoracostomy tube. Nineteen (9%) patients needed urgent thoracotomy: 4 (1.9%) cases for penetrating injury and 15 (7.1%) cases for blunt trauma. Three (1.4%) patients treated with urgent thoracotomy required concomitant laparotomy for intra-abdominal injuries. The overall mortality rate was 1.4%.
  
  
  RESULTS
  We report three cases of urgent lobectomies for chest trauma without mortality and with postoperative complete restoration of respiratory function. The anatomical lobectomies were performed for: massive hemothorax with bronchial disruption, expanding pulmonary hematoma with hypovolemic shock, and massive hemothorax in deep parenchymal laceration.
  
  
  CONCLUSIONS
  Mortality rate after major pulmonary resections for trauma is very high and increases with the presence of multivisceral injuries, the severity of hypovolemic shock and extent of lung resection. Anterolateral thoracotomy was the approach employed in case of cardiac arrest. In hypovolemic patients a posterolateral incision with a double lumen intubation was performed. The absence of mortality in this series may be related to the prompt diagnosis, short operative time and absence of associated severe neurological or abdominal injuries.
authors: Department of Surgery, Ospedale Alessandro Manzoni, Lecco, Italy ;
authors: Marco
authors: M
authors: Chiarelli
authors: Department of Surgery, Ospedale Alessandro Manzoni, Lecco, Italy ;
authors: Martino
authors: M
authors: Gerosa
authors: Department of Surgery University of Milan-Bicocca, Istituti Clinici Zucchi Monza, Italy ;
authors: Angelo
authors: A
authors: Guttadauro
authors: Department of Surgery University of Milan-Bicocca, Istituti Clinici Zucchi Monza, Italy ;
authors: Francesco
authors: F
authors: Gabrielli
authors: Department of Surgery, Ospedale Alessandro Manzoni, Lecco, Italy ;
authors: Giuseppe
authors: G
authors: Vertemati
authors: Department of Emergency, Ospedale Alessandro Manzoni, Lecco, Italy ;
authors: Massimo
authors: M
authors: Cazzaniga
authors: Department of Surgery, Ospedale Alessandro Manzoni, Lecco, Italy ;
authors: Luca
authors: L
authors: Fumagalli
authors: Department of Surgery, University of Milan, Milan, Italy.
authors: Matilde
authors: M
authors: De Simone
authors: Department of Surgery, University of Milan, Milan, Italy.
authors: Ugo
authors: U
authors: Cioffi
keywords: Urgent pulmonary lobectomy; chest trauma; surgery