Neoadjuvant chemotherapy is a risk factor for bronchopleural fistula after pneumonectomy for non-small cell lung cancer

Samancılar, Özgür; Kaya, Şeyda Örs; Usluer, Ozan; Öztürk, Taner

doi:10.5114/kitp.2014.41929

Cited by 4 publications

(12 citation statements)

References 22 publications

(23 reference statements)

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“…However, the pooled OR for NC group appeared an obvious trend towards the increased risk of BPF (OR: 1.857; 95%CI: 0.881-3.911; P = 0.104). Two studies with nearly 1000 surgical patients also demonstrated the significant relationship between NC and occurrence of BPF (42,45). Therefore, the actual effects of NC on risk of BPF need further affirmations and modifications in the future studies based on a larger sample size.…”

Section: Discussionmentioning

confidence: 99%

“…3B). The summarized outcomes integrating 12 available studies (21,26,34,35,37,38,42,(44)(45)(46)(47)50) revealed the higher frequency of BPF occurred in patients treated with NC compared with those without NC (OR: 1.857; 95%CI: 0.881-3.911). However, the current evidences did not show the significant impact of NC on BPF occurrence after lung cancer surgery (P = 0.104).…”

Section: Subgroup Analysismentioning

confidence: 99%

“…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).…”

Section: The Basic Characteristics Of Included Studiesmentioning

confidence: 99%

“…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.…”

Section: The Basic Characteristics Of Included Studiesmentioning

confidence: 99%

“…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).…”

Section: The Statistical Characteristics Of Included Studiesmentioning

confidence: 99%

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

Fan

Liu

et al. 2016

Jpn. J. Clin. Oncol.

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Objective: Neoadjuvant therapy has been extensively analyzed in studies addressing the risk factors of bronchopleural fistula, but their results vary hugely. Therefore, we conducted this meta-analysis to determine the association between neoadjuvant therapy and risk of bronchopleural fistula in patients undergoing lung cancer surgery. Methods: We searched PubMed and EMBASE to identify the full-text literatures that met our eligibility criteria. Odds ratio with 95% confidence interval served as the summarized statistics. Heterogeneity within this meta-analysis was evaluated by Q-test and I 2 statistic. Sensitivity analysis was performed for further assessments of robustness. Publication bias was detected by Begg's test and Egger's test.Results: Thirty studies enrolling 14 912 lung cancer cases were included into this meta-analysis. The incidence of bronchopleural fistula was 2.4% (354/14 912) in the large scale. Overall, neoadjuvant therapy significantly increased the risk of bronchopleural fistula after pulmonary resections (odds ratio: 2.166; 95% confidence interval: 1.398-3.357; P = 0.001). In subgroup analysis, neoadjuvant radiotherapy (odds ratio: 3.914; 95% confidence interval: 1.401-10.935; P = 0.009) and chemo-radiation (odds ratio: 2.533; 95% confidence interval: 1.353-4.741; P = 0.004) were significantly associated with the bronchopleural fistula risk but neoadjuvant chemotherapy was not (odds ratio: 1.857; 95% confidence interval: 0.881-3.911; P = 0.104). The impact of neoadjuvant therapy on bronchopleural fistula occurrence remains statistically prominent in the other subgroups. Conclusions: Neoadjuvant therapy is significantly associated with the occurrence of bronchopleural fistula after lung cancer surgery. Both neoadjuvant radiotherapy and chemo-radiation significantly increase the bronchopleural fistula risk but neoadjuvant chemotherapy does not. Some limitations still exist in this meta-analysis. The updated high-quality studies can help to further confirm and enrich our discoveries in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Subgroup Analysismentioning

confidence: 99%

Section: The Basic Characteristics Of Included Studiesmentioning

confidence: 99%

Section: The Basic Characteristics Of Included Studiesmentioning

confidence: 99%

Section: The Statistical Characteristics Of Included Studiesmentioning

confidence: 99%

See 3 more Smart Citations

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

Fan

Liu

et al. 2016

Jpn. J. Clin. Oncol.

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

Peng

Mei

Liu

et al. 2022

Transl Lung Cancer Res

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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.

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Postpneumonectomy bronchopleural fistula: cohort of patients in a pevurian national hospital

Gonzales-peña,

Cubas,

Villanueva-zúñiga

2023

Curr Thorac Surg

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Background: Bronchopleural fistula (BPF) is a complication with a great impact on morbidity, mortality and survival in postoperative pneumonectomy patients. Our study aimed to determine the associated clinical-surgical characteristics of the BPF in a Peruvian cohort of patients with BPF following pneumonectomy Materials and Methods: Cross-sectional, and retrospective study during January 2015-June 2020 in a Peruvian National Hospital. Medical records and operative reports were reviewed, and all patients over age (>18 years) and with all-cause pneumonectomy were considered. The variables were grouped into pneumonectomies with and without BPF, and the characteristics were grouped as a baseline, clinicalsurgical and postoperative.Results: Among fifty-seven patients who underwent pneumonectomy, 28% presented BPF. The mean age was 38.3 ± 15 years, and 62.5% were male. The main pathologies associated with BPF were posttuberculosis fibrocavitary sequelae (62.5%), pulmonary hydatidosis (18.8%), and post-surgical cavitary sequelae (12.5%). 81.3% were left BPF (p = 0.342) and 100% were related to postoperative empyema (p < 0.05). The mortality associated with BPF was 6.25%, and in the non-BPF group it was 4.87% (p = 0.098). Characteristics that were statistically associated with the presence of bronchopleural fistula were low predicted forced expiratory volume (FEV1) (56.3% vs. 31.7%; p = 0.046), preoperative empyema (37.5% vs. 2.4%; p = 0.001), postoperative empyema (100% vs. 9.8%; p = 0.000) and operative time (450.69 min vs. 367.73 min; p = 0.032).Conclusions: There are a series of factors associated with the presence of patients with BPF following pneumonectomy, many of them mainly related to operative and postoperative events, which is an important predictor of associated complications in our Peruvian population.

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Neoadjuvant chemotherapy is a risk factor for bronchopleural fistula after pneumonectomy for non-small cell lung cancer

Cited by 4 publications

References 22 publications

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

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

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

Postpneumonectomy bronchopleural fistula: cohort of patients in a pevurian national hospital

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