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BackgroundResults of studies to predict prolonged air leak (PAL; air leak longer than 5 days) after pulmonary lobectomy have been inconsistent and are of limited use. We developed a new scale representing the amount of early postoperative air leak and determined its correlation with air leak duration and its potential as a predictor of PAL.MethodsWe grade postoperative air leak using a 5-grade scale. All 779 lobectomies from January 2005 to December 2009 with available medical records were reviewed retrospectively. We devised six ‘SUM’ variables using air leak grades in the initial 72 h postoperatively.ResultsExcluding unrecorded cases and postoperative broncho-pleural fistulas, there were 720 lobectomies. PAL occurred in 135 cases (18.8%). Correlation analyses showed each SUM variable highly correlated with air leak duration, and the SUM4to9, which was the sum of six consecutive values of air leak grades for every 8 h record on postoperative days 2 and 3, was proved to be the most powerful predictor of PAL; PAL could be predicted with 75.7% and 77.7% positive and negative predictive value, respectively, when SUM4to9 ≥ 16. When 4 predictors derived from multivariable logistic regression of perioperative variables were combined with SUM4to9, there was no significant increase in predictability compared with SUM4to9 alone.ConclusionsThis simple new method to predict PAL using SUM4to9 showed that the amount of early postoperative air leak is the most powerful predictor of PAL, therefore, grading air leak after pulmonary lobectomy is a useful method to predict PAL.

Simpson grade II removal may be an alternative option if the risk of complications with Simpson grade I removal is expected to be high.

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Squamous cell carcinoma of the head and neck (SCCHN) accounted for 3.5% of all cancers registered in Korea during 2001. Although tobacco smoking and alcohol consumption are known risk factors of SCCHN, only a small fraction of the populations exposed to tobacco or alcohol develop SCCHN. Therefore, differences in the susceptibility of SCCHN with respect to DNA repair and xenobiotic metabolisms have focused upon attempts to determine the causes of SCCHN. Here, we investigated factors that affect ERCC1 mRNA expression in peripheral blood. The study subjects were all Koreans (67 patients and 73 control subjects); 72.9% of all subjects were male; 68.4% were current or former smokers; and 62.4% were current or former alcohol drinkers. We also studied the association between ERCC1 mRNA expression and the C8092A polymorphism of ERCC1, and found lower ERCC1 mRNA expression in SCCHN patients than in controls (P<0.01). In the present study, we found that ERCC1 C8092A polymorphism is not related to the risk of SCCHN or expression of ERCC1 mRNA. In addition, we found a positive association between ERCC1 mRNA expression in peripheral blood and tumour tissues and inverse associations between ERCC1 mRNA expression and age or the number of cigarettes smoked. Therefore, our study suggests that ERCC1 mRNA expression is reduced by age and smoking and has a weak effect on SCCHN risk as compared with the effects of age and tobacco-smoking expression.