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Low incidence of bronchopleural fistula after pneumonectomy for lung cancer

^a Department of Cardiothoracic Surgery, Patras University School of Medicine, Patras 26500, Greece
^b Department of Thoracic and Vascular Surgery, Evangelismos General Hospital, Athens 10676, Greece
^c Department of Medical Physics, Patras University School of Medicine, Patras 26500, Greece

*Corresponding author. 31, Chlois Str., Voula, 166 73, Athens, Greece. Tel.: +30 210 8955570; fax: +30 210 8955570.

E-mail address: ekoletsis{at}hotmail.com (E. Koletsis).

Bronchopleural fistula (BPF) after pneumonectomy for NSCLC remains a highly morbid complication. We examined possible factors including the surgical techniques associated with BPF development. From 221 pneumonectomies for NSCLC, bronchial stump closure was mechanically performed in 192 patients and manually in the remaining 29. In all right-sided pneumonectomies mechanical closure was performed with associated stump coverage. In 114/130 left-sided procedures where mechanical closure was selected, bronchial stump remained uncovered. In the remaining 16 left-sided cases where manual stump closure was selectively performed, the stump was covered utilizing various tissues. Risk factors were classified into preoperative, intra-operative and postoperative. Five patients (2.3%) developed BPF. Univariate analysis revealed peri-operative transfusion, respiratory infection at the time of presentation, neoadjuvant therapy, right-sided pneumonectomy, manual type of bronchial closure, days of postoperative hospitalization and mechanical ventilation as significant risk factors for BPF development. Multivariate analysis followed revealing preoperative respiratory infection and right pneumonectomy as the only independent risk factors. In our series, a selected stump coverage policy showed a low incidence of BPF development. Mechanical stapling was superior to manual closure, although not as an independent factor. Early recognition of possible risk factors associated with fistula development is of paramount importance.

Key Words: Bronchopleural fistula; Pneumonectomy; Lung cancer; Bronchial stump

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eComment: Defective bronchial tissue homeostasis following neoadjuvant therapy for lung cancer

Thorsten Walles, Martina Hampel, Iris Dally, and Godehard Friedel
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				T. Walles, M. Hampel, I. Dally, and G. Friedel eComment: Defective bronchial tissue homeostasis following neoadjuvant therapy for lung cancer Interactive CardioVascular and Thoracic Surgery, October 1, 2009; 9(4): 575 - 575. [Full Text] [PDF]