Abstract
Purpose
Bronchopleural fistula (BPF) remains an important source of morbidity and mortality after right pneumonectomy. We reviewed our 18-year institutional experience with right pneumonectomy to identify risks factors for BPF.
Methods
From 1992 to 2010, a total of 145 patients who underwent right pneumonectomy were identified from an institutional database. Median age was 56 years. Most patients (66.2%) underwent surgery for non–small cell lung cancer. Sixty-seven patients (46.2%) received either chemotherapy or radiotherapy before surgery. Medical records were reviewed for 14 variables potentially predictive for BPF, including two airway closure techniques (standard bronchial closure and carinal closure). Variables predictive of BPF by univariate analysis were entered into a logistic regression model.
Results
The overall mortality rate was 13.1% (n = 19), with 15.9 and 10.5% mortality in the bronchial closure and carinal closure groups, respectively (P = 0.33). The overall BPF rate was 7.6% (n = 11), with a 3.9% (3 of 76) rate in the carinal closure group compared to 11.6% (8 of 69) in the bronchial closure group (P = 0.08). Seven of eight bronchial closure patients who developed BPF required operative repair. Only one of three patients who developed BPF after carinal closure did not spontaneously heal after open drainage. Multivariate analysis identified preoperative radiation dose (P = 0.042) and bronchial closure (P = 0.041) as independent risk factors for BPF, while the length of postoperative ventilation before development of BPF approached significance (P = 0.057).
Conclusions
In our experience, higher preoperative radiation doses are a risk factor for BPF after right pneumonectomy, while carinal closure exerts a protective effect.
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References
Deslauriers J, Aucoin A, Gregoire J. Postpneumonectomy pulmonary edema. Chest Surg Clin N Am. 1998;8:611–31.
Darling GE, Abdurahman A, Yi QL, et al. Risk of a right pneumonectomy: role of bronchopleural fistula. Ann Thorac Surg. 2005;79:433–7.
Kesler KA, Hammoud ZT, Rieger KM, Kruter LE, Yu M, Brown JW. Carinaplasty airway closure: a technique for right pneumonectomy. Ann Thorac Surg. 2008;85:1178–85.
Wright CD, Wain JC, Mathisen DJ, Grillo HC. Postpneumonectomy bronchopleural fistula after sutured bronchial closure: incidence, risk factors, and management. J Thorac Cardiovasc Surg 1996;112:1367–71.
Deschamps C, Bernard A, Nichols FC 3rd, et al. Empyema and bronchopleural fistula after pneumonectomy: factors affecting incidence. Ann Thorac Surg. 2001;72:243–7.
Alexiou C, Beggs D, Rogers ML, Beggs L, Asopa S, Salama FD. Pneumonectomy for non–small cell lung cancer: predictors of operative mortality and survival. Eur J Cardiothorac Surg. 2001;20:476–80.
Gudbjartsson T, Gyllstedt E, Pikwer A, Jonsson P. Early surgical results after pneumonectomy for non–small cell lung cancer are not affected by preoperative radiotherapy and chemotherapy. Ann Thorac Surg. 2008;86:376–82.
Hubaut JJ, Baron O, Al Habash O, Despins P, Duveau D, Michaud JL. Closure of the bronchial stump by manual suture and incidence of bronchopleural fistula in a series of 209 pneumonectomies for lung cancer. Eur J Cardiothorac Surg. 1999;16:418–23.
Stamatis G, Djuric D, Eberhardt W, et al. Postoperative morbidity and mortality after induction chemoradiotherapy for locally advanced lung cancer: an analysis of 350 operated patients. Eur J Cardiothorac Surg. 2002;22:292–7.
Kim AW, Faber LP, Warren WH, et al. Pneumonectomy after chemoradiation therapy for non–small cell lung cancer: does “side” really matter? Ann Thorac Surg. 2009;88:937–43.
Sirbu H, Busch T, Aleksic I, Schreiner W, Oster O, Dalichau H. Bronchopleural fistula in the surgery of non–small cell lung cancer: incidence, risk factors, and management. Ann Thorac Cardiovasc Surg. 2001;7:330–6.
Algar FJ, Alvarez A, Aranda JL, Salvatierra A, Baamonde C, Lopez-Pujol FJ. Prediction of early bronchopleural fistula after pneumonectomy: a multivariate analysis. Ann Thorac Surg. 2001;72:1662–7.
Panagopoulos ND, Apostolakis E, Koletsis E, et al. Low incidence of bronchopleural fistula after pneumonectomy for lung cancer. Interact Cardiovasc Thorac Surg. 2009;9:571–5.
Jack GD. Bronchial closure. Thorax. 1965;20:8–12.
Sonett JR, Suntharalingam M, Edelman MJ, et al. Pulmonary resection after curative intent radiotherapy (> 59 Gy) and concurrent chemotherapy in non-small-cell lung cancer. Annals Thorac Surg. 2004;78:1200–5.
Daly BD, Fernando HC, Ketchedjian A, et al. Pneumonectomy after high-dose radiation and concurrent chemotherapy for nonsmall cell lung cancer. Annals Thorac Surg. 2006;82:227–31.
Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374(9687):379–86.
Sarsam MA, Moussali H. Technique of bronchial closure after pneumonectomy. J Thorac Cardiovasc Surg. 1989;98:220–3.
Anderson TM, Miller JI Jr. Use of pleura, azygos vein, pericardium, and muscle flaps in tracheobronchial surgery. Ann Thorac Surg. 1995;60:729–33.
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Birdas, T.J., Morad, M.H., Okereke, I.C. et al. Risk Factors for Bronchopleural Fistula After Right Pneumonectomy: Does Eliminating the Stump Diverticulum Provide Protection?. Ann Surg Oncol 19, 1336–1342 (2012). https://doi.org/10.1245/s10434-011-2119-z
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DOI: https://doi.org/10.1245/s10434-011-2119-z