[Thoracic Surgery and Perioperative Management for Hemodialysis Patients]

The number of patients receiving hemodialysis has increased, and a proportionate increase of such patients with malignant tumor is expected. Hemodialysis patients are associated with a special condition, which is an obstacle during surgery. Surgery for dialysis patients is associated with high risk due to heart failure, respiratory failure, bleeding tendency, and immunosuppression. Therefore, dialysis patients should undergo sufficient preoperative evaluation and course of dialysis before surgery. In addition, minimally invasive surgery are required to reduce a risk of postoperative complication, and recently video-assisted thoracic surgery is performed. To reduce bleeding, using nafamostat mesilate on hemodialysis is also important management method. Careful infusion is necessary because volume overload causes the most dangerous complications, heart failure and pulmonary edema. Because dialysis patients are easily infected, sufficient care must be taken for wound infection, pneumonia, and empyema. Dialysis patients require careful perioperative management, but standard surgery is possible. However, prognosis for lung cancer with hemodialysis patient is not satisfactory. Future research on postoperative therapy including anticancer drugs is expected.