This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thorsten Walles Godehard Friedel Permission Requests Google Scholar Articles by Walles, T. Articles by Friedel, G. PubMed PubMed Citation Articles by Walles, T. Articles by Friedel, G. Related Collections Related Article

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

Department of General Thoracic Surgery, Schillerhöhe Hospital, Solitudestr. 18, 70839 Gerlingen, Germany

Low incidence of bronchopleural fistula after pneumonectomy for lung cancer

With interest we read the recent institutional report of Panagopoulos and colleagues [1]. The authors are complimented on their meticulous analysis of 221 cases and the low rate of bronchopleural fistulas (BPF) at their institution. In their analysis, they identified preoperative respiratory infection and right pneumonectomy as the only independent risk factors for postoperative BPF. Interestingly, three of 14 patients (21%) who had received neoadjuvant therapy developed BPF (P=0.002), however, this finding did not turn out to be significant in the multivariate analysis. All three patients had undergone right-sided pneumonectomy and stump coverage by mobilization of the azygos vein and the surrounding parietal pleura or a pericardial flap following intra-pericardial pneumonectomy. In contrast, only two of the 207 patients without induction therapy developed BPF – invariably on the right side. While BPF occurred in these two patients already 7 and 12 days after surgery, it only emerged 14, 30 and 70 days postoperatively in those three patients following neoadjuvant therapy. Thus, it can be hypothesized that impaired wound healing rather than technical failure of stump closure may be accountable for the delayed occurrence of BPF in those three patients following induction therapy. And, if so, the underlying mechanisms would deserve further investigation in the light of a conceivable increase of multimodal protocols in the treatment of lung cancer [2].

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1. Panagopoulos N, Apostolakis E, Koletsis E, Prokakis C, Hountis P, Sakellaropoulos G, Bellenis I, Dougenis D. Low incidence of bronchopleural fistula after pneumonectomy for lung cancer. Interact CardioVasc Thorac Surg 2009;9:571–575.[Abstract/Free Full Text]
2. Steger V, Walles T, Kosan B, Walker T, Kyriss T, Veit S, Dippon J, Friedel G. Trimodal therapy for histologically proven N2/3 non-small cell lung cancer: mid-term results and indicators for survival. Ann Thorac Surg 2009;87:1676–1683.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thorsten Walles Godehard Friedel Permission Requests Google Scholar Articles by Walles, T. Articles by Friedel, G. PubMed PubMed Citation Articles by Walles, T. Articles by Friedel, G. Related Collections Related Article