Analysis of risk factors in bronchopleural fistula after pulmonary resection for primary lung cancer

Abstract

The main and intermediate bronchial stumps, and the stumps in cases with previous ipsilateral thoracotomy or receiving induction therapy are prone to BPFs. Preventive coverage should be considered for these stumps. Our methods for reinforcement of stapled stumps are thought to be reliable.

Neoadjuvant therapy and risk of bronchopleural fistula after lung cancer surgery: a systematic meta-analysis of 14 912 patients

“…Asian patients provided 77.2% of the enrolled samples (11 510/14 912) (23,30,31,34,35,40,42,45,46,49,50), including 6923 cases from China (31,35), 4347 cases from Japan (23,30,34,40,42,49,50), 177 cases from Turkey (45) and 63 cases from Korea (46). The other 3402 patients (3402/14 912, ratio = 22.8%) were from European and North American countries and reported in 19 studies (21,22,(24)(25)(26)(27)(28)(29)32,33,(36)(37)(38)(39)41,43,44,47,48).…”

“…NC was generally applied in most of the included studies. Twelve studies independently analyzed the effects of NC (21,26,34,35,37,38,42,(44)(45)(46)(47)50), another 11 studies analyzed the effects of neoadjuvant chemo-radiation (NCR) (24,(27)(28)(29)32,33,(39)(40)(41)44,49), and another four studies investigated the association between NR and BPF risk (23,46,48,50). Besides, the remaining studies (22,25,30,31,36,43) enrolled both NC cases and NR cases but analyzed them together, without providing any extractable detail on each strategy.…”

“…The operations performed on lung cancer patients included pneumonectomy (21,22,25,26,(29)(30)(31)33,34,(36)(37)(38)(39)(40)(43)(44)(45)(46)(47)(48), lobectomy (32,42) and bronchoplasty (24,27,28,41). Four large-scale studies enrolled 9570 patients (9570/14 912, ratio = 64.2%) undergoing multiple types of resections but did not report the details of BPF occurrence in each operative mode (23,35,49,50). Other available characteristics of the included studies, including ages and clinical stages, are also listed in Table 1.…”

“…Thirteen included studies (21,24,(26)(27)(28)(29)32,(37)(38)(39)41,44,45) analyzed the differences in BPF development between the patients undergoing NT followed by operations and those undergoing operations alone (NT + surgery vs. surgery alone) ( Table 2). The other 17 included studies (22,23,25,30,31,(33)(34)(35)(36)40,42,43,(46)(47)(48)(49)(50) classified 12 919 patients (12 919/14 912, ratio = 86.6%) by BPF occurrence, and evaluated the risk factors of BPF based on the patients with BPF and without BPF (BPF vs. non-BPF) ( Table 2). Furthermore, more than half of these 17 studies (22,23,30,31,35,40,42,43,47) performed both univariate analysis and multivariate analysis to comprehensively identify the independent factors of BPF.…”

Treatments of post-surgical fistulas with particular emphasys to stem cells therapy

“…It may be caused by incomplete bronchial closure, impediment of bronchial stump wound healing, or stump destruction by residual neoplastic tissue. The incidence of BPF after thoracic surgery for lung cancer ranges from 1 to 4%, whilst its mortality ranges from 12.5 to 71.2% (2). BPF is still the most feared complication after curative lung resection (3); for this reason the healing effects promoted by stem cells -by transformation into mature cells with a specialized function or by enhancing intrinsic repair mechanismsmay represent an effective and only partially explored therapeutic option (4,5).…”