Air leaks following pulmonary resection for lung cancer: is it a patient or surgeon related problem?

Abstract

INTRODUCTIONProlonged air leak (PAL) is the most common complication after partial lung resection and the most important determinant of length of hospital stay for patients post-operatively. The aim of this study was to determine the risk factors involved in developing air leaks and the consequences of PAL.METHODSAll patients undergoing lung resection between January 2002 and December 2007 in our hospital were studied retrospectively. Univariate analysis to predict risk factors for developing post-operative air leaks included patient demographics, smoking status, pulmonary function tests, disease aetiology (benign, malignant), neoadjuvant therapy (pre-operative radiotherapy/chemotherapy), extent and type of resection, and different consultant surgeons’ practice. A logistic regression model was used for multivariate analysis.RESULTSA total of 1,911 lung resections were performed over the 6-year study period. An air leak lasting more than 6 days post-operatively was present in 129 patients (6.7%). This included 100 out of the 1,250 patients (8%) from the lobectomy group and 29 out of the 661 patients (4.4%) from the wedge/segmentectomy group. Using the multivariate analysis, the risk factors for developing an air leak included a low predicted forced expiratory volume in 1 second (pFEV1) (p<0.001), performing an upper lobectomy (p=0.002) and different consultant practice (p=0.02). PAL was associated with increased length of stay (p<0.0001), in-hospital mortality (p=0.003) and intensive care unit readmission (p=0.05).CONCLUSIONSAir leaks after pulmonary resections were at an acceptable rate in our series. Particular patients are at a higher risk but meticulous surgical technique is vital in reducing their incidence. Our study shows that pFEV1is the strongest predictor of post-operative air leaks.

Safety and feasibility of uniportal video-assisted thoracoscopic surgery for locally advanced non-small cell lung cancer

“…The frequency of prolonged air leak observed in our uniportal VATS (17.2%) less than those in open group (35.3%). In other series, upper lobectomy was a greater risk factor for developing prolong air leak compared with other resection, because they often result in a large apical air space (20,21). In our series, prolonged air leak mainly observed in the case of upper lobectomy or bilobectomy.…”

Effect of gender on perioperative outcomes after robotic-assisted pulmonary lobectomy

“…Lower rates of smoking, COPD, and pre-existing cardiovascular disease in women better explain differences in prolonged air leaks, and consequently in chest tube days and hospital LOS, as FEV1 ≤80% of predicted is a known risk factor (35,36). In our multivariable analyses of perioperative outcomes, including intraoperative EBL, operating time and hospital LOS, female gender was not found to be an independent predictor of these outcomes.…”

The effect of fibrin sealant spraying on prolonged air leak after pulmonary resections: a single center experience

“…Many research studies were conducted in order to find possible methods to avoid or reduce this complication [13][14][15]. This complication leads to an increased risk for development of pneumothorax, bronchopleural fistulae, infections and, consequently, a prolonged hospital stay and higher healthcare costs.…”