Methods of main bronchus stump closure and incidence of bronchopleural fistula after pneumonectomies for lung cancer (a retrospective single center review)

Abstract

Background. Bronchopleural fistulas (BPFs) development after pneumo nectomy remains a serious complication and is associated with high mortality rate. We evaluated incidence and risk factors, that influenced BPF rate after pneumonectomies for lung cancer patients treated at the Department of Thoracic Surgery and Oncology of the Institute of Oncology, Vilnius University, and compared different bronchial stump suturing techniques. Methods. It is a retrospective study. We reviewed 580 lung cancer patients who underwent pneumonectomies from January 1990 to January 2009. The average patient's age was 60.1 ± 7.9 years (range from 34 to 76). Patients according to postoperative staging: stage IIA-30 patients, IIB-80, IIIA-320, IIIB-96, IV-54. The most common tumor histology was planocellular carcinoma-301, adenocarcinoma-108, small-cell carcinoma-76. Results. There were 327 (56.4%) right and 253 (43.6%) left pneumonectomies. Mediastinal lymph node dissection (LND) was performed to 387 (66.7%) and lymph node sampling (LNS) to 193 (33.3%) patients. The bronchial stump was covered in 285 (49.1%) patients. Bronchopleural fistula after pneumonectomy developed in 48 (8.3%) patients (bronchial dehiscence was confirmed by bronchoscopy), and 7 patients with BPF died (14.5%). BPF after right pneumonectomy occurred in 30 cases (9.5%) and after left pneumonectomy in 18 cases (7.1%), the difference was not statistically significant (p > 0.05). BPF after LND occurred in 38 cases (9.82%) and after LNS in 10 cases (5.18%), the diff erence was statistically significant (p < 0.05). BPF rate using suturing devices with changeable staples (UKL-40, UKL-60, UO-40, UO-60) was 12.6%, using me chanical staplers and handmade suture it was 4.1% and 8.8%, respectively. The difference between the groups was statistically significant (p = 0.0071). Conclusions. 1. BPF rate after pneumonectomies for lung cancer patients was lowest using mechanical staplers (4.1%). 2. BPF occurrence rate after right and left pneumonectomy had no statistically significant difference. 3. BPF rate after pneumonectomy was higher in the LND group (9.82%) than in the LNS group (5.18%), the difference was statistically significant (p < 0.05).

The technique of stump closure has no impact on post-pneumonectomy bronchopleural fistula in the non-small cell lung cancer—a cross-sectional study

“…Nevertheless, the superiority of stapler over manual sutures in preventing BPF remains controversial (12). Several studies have reported a lower incidence of BPF after stapler closure compared to manual suturing (11,22,23), while others report a similar incidence between both techniques (24). Beyond the scope of this paper, in recent years, videoassisted thoracic surgery (VATS) pneumonectomy has been performed in selected cases (25), which requires the use of staplers in most situations (26).…”

“…It affects 1.5-12.5% of NSCLC patients undergoing pneumonectomy (5,8,9), leading to lifethreatening complications, such as respiratory insufficiency, pneumonia, empyema, and sepsis in the remaining lung. Furthermore, 13-67% of individuals who develop BPF after pneumonectomy dies within 30 days after the operation (8)(9)(10)(11).…”

“…To reduce the occurrence of BPF, several surgical methods may improve bronchial stump vascularization. The main principle of this surgical technique involves making a short and firmly closed bronchial stump (7,10,11). Many surgeons consider it worthwhile to buttress the bronchial stump with well-perfused tissues like an intercostal muscle flap (IMF), parietal pleura, pericardium, and mediastinal fat (12,13).…”