Low incidence of bronchopleural fistula after pneumonectomy for lung cancer

Abstract

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.

Conservative management of empyema-complicated post-lobectomy bronchopleural fistulas: experience of consecutive 13 cases in 9 years

“…Moreover, in study of Asamura et al (1), the incidence of BPF after manual suture (4%) was higher than that after stapler suture (1%), but no significant difference was found. Moreover, similar result was also found by Panagopoulos's research (12). A bronchial fistula creates a passage between the retaining pleural cavity and patient's airway conduit.…”

“…Various risk factors as neoadjuvant therapy and closure of bronchial stump, had been reported (1,(10)(11)(12). In current study, no case in our cohort administrated neoadjuvant therapy.…”

Neoadjuvant therapy and risk of bronchopleural fistula after lung cancer surgery: a systematic meta-analysis of 14 912 patients

“…Asian patients provided 77.2% of the enrolled samples (11 510/14 912) (23,30,31,34,35,40,42,45,46,49,50), including 6923 cases from China (31,35), 4347 cases from Japan (23,30,34,40,42,49,50), 177 cases from Turkey (45) and 63 cases from Korea (46). The other 3402 patients (3402/14 912, ratio = 22.8%) were from European and North American countries and reported in 19 studies (21,22,(24)(25)(26)(27)(28)(29)32,33,(36)(37)(38)(39)41,43,44,47,48). Postoperative BPF was diagnosed in 354 patients by endoscopic inspection and clinical manifestation.…”

“…Twelve studies independently analyzed the effects of NC (21,26,34,35,37,38,42,(44)(45)(46)(47)50), another 11 studies analyzed the effects of neoadjuvant chemo-radiation (NCR) (24,(27)(28)(29)32,33,(39)(40)(41)44,49), and another four studies investigated the association between NR and BPF risk (23,46,48,50). Besides, the remaining studies (22,25,30,31,36,43) enrolled both NC cases and NR cases but analyzed them together, without providing any extractable detail on each strategy. The operations performed on lung cancer patients included pneumonectomy (21,22,25,26,(29)(30)(31)33,34,(36)(37)(38)(39)(40)...…”

“…Besides, the remaining studies (22,25,30,31,36,43) enrolled both NC cases and NR cases but analyzed them together, without providing any extractable detail on each strategy. The operations performed on lung cancer patients included pneumonectomy (21,22,25,26,(29)(30)(31)33,34,(36)(37)(38)(39)(40)(43)(44)(45)(46)(47)(48), lobectomy (32,42) and bronchoplasty (24,27,28,41). Four large-scale studies enrolled 9570 patients (9570/14 912, ratio = 64.2%) undergoing multiple types of resections but did not report the details of BPF occurrence in each operative mode (23,35,49,50).…”