[Lung resection for lung cancer patients on hemodialysis]

Patients on hemodialysis (HD) who undergo lung resection represent a high risk group requiring a careful perioperative management. To access a cardiac risk of HD patients a complete cardiac examination must be conducted preoperatively. The patients should undergo sufficient courses of HD to ameliorate electrolyte imbalance and volume disturbance before surgery. An elective operation should be scheduled on the day after HD. During operation, gentle operative maneuver and complete hemostatic technique are required to reduce a risk of postoperative bleeding. An adequate amount of antibiotics should be administrated to avoid a surgical site infection. Pulmonary edema due to volume overload and hyperkalemia are the most dangerous postoperative complications. Infusion should be conducted with potassium-free solution at 20~40 ml/h until the restart of HD. HD could be safely performed with nafamostat mesilate on the day after operation in most patients. If hyperkalemia and pulmonary edema are resistant to conservative managements, an emergency HD is required. Prognosis after lung resection for lung cancer patients on HD is not satisfactory. Many patients die of non cancer related causes such as heart failure and infection. Long term management of the underlying renal condition is necessary to improve their postoperative survival.