Risk factors and outcomes of bronchopleural fistula after bronchoplasty in patients with non-small cell lung cancer: a retrospective multivariate analysis

Abstract

Background: Bronchopleural fistula (BPF) is a rare but severe complication following bronchoplasty.Identification of the risk factors for the development of BPF after bronchoplasty may contribute to better perioperative management, thereby further improving the prognosis of these patients. However, few studies have focused on the risk factors for BPF after bronchoplasty. This study aimed to explore the risk factors and outcomes for BPF after bronchoplasty in patients with non-small cell lung cancer (NSCLC). Methods: The data of NSCLC patients who underwent bronchoplasty between September 2005 and August 2020 in our institution were retrospectively reviewed. Detailed information on demographic characteristics, preoperative assessment, perioperative outcomes were collected from Western China Lung Cancer Database. The diagnosis of BPF was confirmed by bronchoscopy. Risk factors for BPF were assessed by univariate and multivariate logistic regression analysis. Results: A total of 503 patients were included in this study, including 132 (26.2%) cases of bronchovascular plasty, 340 (67.6%) cases of bronchial sleeve lobectomy, and 31 (6.2%) cases of bronchial wedge plasty. Among these patients, 16 (3.2%) developed postoperative BPF. Six patients with BPF died during hospital-stay, including two cases of severe hemoptysis, and four cases of pyothorax and respiratory failure caused by BPF. One of the other ten patients underwent reoperation. After univariate and multivariate logistic regression analysis, preoperative Charlson Comorbidity Index (CCI) ≥2 [odds ratio (OR) =5.120, 95% confidence interval (CI): 1.193-21.985, P=0.028], right middle and/or lower lobectomy (OR =4.840, 95% CI: 1.133-20.686, P=0.033), and residual tumor in the bronchial margin (OR =4.160, 95% CI: 1.106-15.644, P=0.035) were identified as independent risk factors for postoperative BPF.Conclusions: Although complication rate of BPF after bronchoplasty is low, the mortality of BPF is high. Patients with higher CCI, those who undergo right middle and/or lower lobectomy, and those with residual tumor in the bronchial margin are at increased risk of BPF. This study highlights the importance of preoperative evaluation and good intraoperative management to prevent this catastrophic complication.

Long-term follow up and comparison between conservative and interventional therapy in postoperative bronchopleural fistula—a cohort study

“…A meta-analysis showed the diabetes mellitus was an independent risk factor for BPF ( 4 ). Besides, malignancy, poor nutritional status, neoadjuvant chemoradiation and surgery played a potential impact on higher incidence of BPF ( 2 , 7 , 11 - 13 ). In the two groups, 41 fistula occurred within 7 days after surgery, 9 occurred after 30 days and the rest occurred between 7 and 30 days in our study.…”

“…The incidence ranges from 0.5% to 20% in different procedures and centers while the mortality rate could reach 70% ( 1 ). Surgical procedures, malignancy, poor nutritional status, neoadjuvant chemoradiation and diabetes are known as the risk factors of BPF ( 2 ). Since the management of BPF with continuous empyema, and the following infection remain challenging and controversial, we try to conclude our own strategy and experience of treatment in postoperative BPF.…”

Complex Sleeve Lobectomy Has Lower Postoperative Major Complications Than Pneumonectomy in Patients with Centrally Located Non-Small-Cell Lung Cancer

“…Vascular complications are more frequently reported after type A and B ESL [14][15][16] and could be prevented with some surgical maneuvers such as complete mobilization of the hilum, U-shaped pericardial release and sometimes the transposition of the inferior pulmonary vein to the superior pulmonary vein [17]. Although the different caliber and greater fragility of the distal bronchial stumps place the bronchial anastomosis at risk of rupture, we do not routinely cover the bronchial anastomosis and reserve this maneuver for patients with established conditions that have altered local blood supply, such as diabetes mellitus or preoperative chemoradiation treatments [13,[24][25][26][27][28]. Our series of CSLs showed an acceptable incidence of bronchopleural fistulas (4.5%), regardless of whether the anastomosis was covered or not.…”

Preventive Esophagomyobronchoplasty as a Reliable Prophylaxis of Bronchial Stump Failure and Bronchopleural Fistula after Pneumonectomy in Lung Cancer

“…Одни авторы демонстрируют преимущества механического шва перед ручным с частотой развития бронхоплеврального свища -1 и 4 % соответственно [1][2][3]. За последние десятилетия развиваются методики превентивной бронхопластики, которые направлены на снижение частоты развития несостоятельности культи бронха и бронхоплевральных свищей [4][5][6]. Среди предложенных методик профилактики несостоятельности культи бронха при пульмонэктомии можно отметить следующие.…”