Postoperative changes of the free pericardial fat pad for bronchial stump coverage

Abstract

Background: Bronchopleural fistula (BPF) remains a serious complication after surgery for lung cancer with bronchial resection. A free pericardial fat pad (FPFP) is applied in high-risk cases to reduce BPF frequency. BPF may occur 6 months after surgery. Thus, we evaluated the residual FPFP volume at 6 months after surgery to estimate the residual FPFP ratio and determine the amount of FPFP to be harvested during surgery. Methods: We retrospectively investigated 40 patients who underwent lobectomy with bronchial stump coverage using FPFP. During surgery, the volume of the harvested FPFP was measured and the FPFP was affixed to the bronchial stump. Further, 6 months after surgery, the residual volume of the installed FPFP was analyzed using a three-dimensional volume analyzer and the residual ratio was calculated. We also evaluated clinicopathological factors influencing the resected FPFP and residual ratio. Results:The median resected FPFP volume was 11 mL. During multivariate analysis, body mass index and surgical approach were found to be significant factors associated with the resected FPFP volume.The median residual FPFP volume was 4.3 (0.4-15.5) mL. The median residual ratio was 0.39 (0.13-0.66).The resected FPFP volume was significantly associated with the residual volume (P<0.001) but not with the residual ratio (P=0.811). No factor was associated with the residual ratio. Conclusions: In all cases, residual FPFP was confirmed at 6 months after surgery and the residual ratio was 40%. It is necessary to determine the volume of FPFP to be harvested while carefully considering the shrinkage ratio.

Novel method for bronchial stump coverage for prevents postpneumonectomy bronchopleural fistula: pedicled thymopericardial fat flap

“…3 ). Nagashima et al [ 18 ] examined the postoperative change of free pericardial fat pad affixed to the bronchial stump and found a significant reduction in the volume of adipose tissue at the end of 6 months. Considering that bronchopleural fistula may occur in some patients in the very late period, we think that it would be more appropriate to use pedicle flaps instead of free harvested tissue.…”

Changes in pedicle pericardial fat tissue around the anastomotic site after tracheobronchoplasty

“…When the volume of the covering fat tissue varied in equal proportions, the average residual volume at 6 months was estimated at 47% (0.61 3/2 = 0.47). The residual volume 6 months postoperatively was 40% (8). Those authors used a free fat pad to cover the bronchial stump.…”

“…CT values of fat tissue ranged from −45 to −195 HU (10). The volume of the residual pericardial fat pad at 6 months postoperatively has been reported at 40% (8). When the volume of the fat tissue was considered to vary in equal proportions, a cutoff value for residual rate of fat tissue area was set at 54% (0.4 2/3 = 0.54) (Fig.…”

“…Although changes in the covering free pericardial fat tissue were investigated in a previous study (8), changes in the covering pedicle pericardial fat tissue have never been addressed. This study aimed to investigate changes in the pedicle pericardial fat tissue used to cover the anastomotic site.…”

To Perform or Not to Perform Surgery for Frail Patients?

“…Did the analyses according to patient frailty in each specialty show differences in the distribution of surgical procedures and operative stress score that reflects such selection bias? Furthermore, even without such changes in surgical procedures, surgeons often spontaneously perform preventive measures, such as omission of lymph node dissection and coverage of the bronchial stump, against complications depending on frailty . These confounding variables were not reflected in the study.…”