Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan

Abstract

Background Broncho-pleural fistula (BPF) and respiratory failure (RF) are life-threatening complications after lung cancer surgery and can result in long-term hospitalization and decreased quality of life. Risk assessments for BPF and RF in addition to mortality and major morbidities are indispensable in surgical decision-making and perioperative care. Methods The characteristics and operative data of 80,095 patients who had undergone lung cancer surgery were derived from the 2014 and 2015 National Clinical Database (NCD) of Japan datasets. After excluding 1501 patients, risk models were developed from these data and validated by another dataset for 42,352 patients derived from the 2016 NCD dataset. Receiver operating characteristic curves were generated for postoperative BPF and RF development. The concordance-index was used to assess the discriminatory ability and validity of the model. Results BPF and RF occurred in 259 (0.3%) and 420 patients (0.5%), respectively, in the model development dataset and in 129 (0.3%) and 198 patients (0.5%), respectively, in the model validation dataset. Characteristic variables including types of surgery and comorbidities were identified as risk factors for BPF and RF, respectively. The concordance indexes of assessments for BPF and RF were 0.847 (p < 0.001) and 0.848 (p < 0.001), respectively, for the development dataset and 0.850 (p < 0.001) and 0.844 (p < 0.001), respectively, for the validation dataset. Conclusions These models are satisfactory for predicting BPF and RF after lung cancer surgery in Japan and could guide preoperative assessment and optimal measures for preventing BPF and RF.

Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer

“…According to data from a national clinical database in Japan, interstitial pneumonia, central nerve system disorder, autoimmune disease, and smoking habit are reported risk factors for BPF. 15) In this study, the only risk factor for BPF identified by multivariate analysis in patients undergoing lobectomy was diabetes (HbA1c ≥8.0). Moreover, although ASO was not identified by multivariate analysis, it is also a possible risk factor.…”

“…Endo et al reported risk factors for BPF drawn from a national clinical database in Japan. 15) Regarding surgical procedure, right pneumonectomy was a stronger risk factor (odds ratio 11.1) than bronchoplasty with segmentectomy or lobectomy (odds ratio 5.4). Admittedly, advanced techniques are required for plastic surgery.…”

“…[21][22][23] However, there is no evidence to support reinforcement of the bronchial stump. 15) The most common materials used to reinforce it are adipose tissue and muscle. For adipose tissue, pedicled or free pericardial fat pad can be easily obtained from the thoracic cavity.…”

A customized, covered metallic stent to repair a postoperative bronchopleural fistula: a promising endobronchial approach

“…Of 798 patients, BPFs developed in 96 (12%), of whom 42 (44%) died within 90 days of operation. In recent large surveys, the frequency of post-operative BPF ranged from 0.3% to 0.9% (2)(3)(4). In a French national database including information on 34,000 patients treated via pulmonary resection, the incidence of post-operative BPF was 0.9% (318 patients), and the associated mortality was 22% (70 patients) (2).…”

“…In a French national database including information on 34,000 patients treated via pulmonary resection, the incidence of post-operative BPF was 0.9% (318 patients), and the associated mortality was 22% (70 patients) (2). In a Japanese national database including information on 78,594 patients who underwent lung cancer resection, the incidence of post-operative BPF was reportedly only 0.3% (259 patients), but mortality within 30 days of surgery was 19% (4). In patients with BPFs, infectious pleural effusions in the thoracic cavity flow into the healthy lung through the fistulae, triggering intractable infectious conditions including pneumonia and sepsis.…”