Thoracic surgery in the era of targeted and/or oral chemotherapies for hematologic malignancies: a hidden hemorrhagic hazard?

Background: Patients treated with oral or targeted therapies for hematologic malignancies represent a growing population among candidates for thoracic surgery. These treatments, along with the underlying hematologic disorders, can impair hemostasis and increase perioperative bleeding risk. However, no specific recommendations currently exist for their perioperative management. XXX.

Methods: We conducted a retrospective monocentric case series of seven patients with hematologic malignancies receiving oral chemotherapy who underwent major lung resection for lung cancer at the University Hospital of Nancy between 2024 and 2025. Data regarding intraoperative blood loss, postoperative drainage, occurrence of hemothorax, transfusion, and need for surgical revision were collected.

Results: Postoperative hemothorax occurred in 71% (5/7) of patients, and 43% required blood transfusion. Two patients (29%) required surgical revision for postoperative bleeding. Median intraoperative blood loss was 100 mL (80–1000 mL), and median postoperative day-1 drainage was 1040 mL (130–2000 mL). Notably, the two patients who discontinued oral chemotherapy before surgery did not experience postoperative bleeding.

Conclusions: An unexpectedly high incidence of postoperative hemorrhagic complications was observed in this small cohort of patients receiving oral or targeted therapies for hematologic malignancies. Although causality cannot be established, these findings support careful multidisciplinary perioperative assessment and warrant further investigation in larger studies.