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

Abstract

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.

Body surface area is a novel predictor for surgical complications following video-assisted thoracoscopic surgery for lung adenocarcinoma: a retrospective cohort study

“…The incidence of chylothorax in our cohort was 3.2%, which was within the confines of chylothorax rates ranged 2.1–4.0% in the literature [10, 21, 22]. Bronchial fistula was another one fatal complication, revealing a devastating leakage from airways into the pleural space [9, 23]. The most recent evidence-based reviews had showed a bronchial fistula rate ranged 2.4–3.9% following lung cancer surgery [23–25].…”

Conservative management of empyema-complicated post-lobectomy bronchopleural fistulas: experience of consecutive 13 cases in 9 years

“…Various risk factors as neoadjuvant therapy and closure of bronchial stump, had been reported (1,(10)(11)(12). In current study, no case in our cohort administrated neoadjuvant therapy.…”

“…However, a study performed in our hospital demonstrated that neoadjuvant therapy was independently associated with BPF after pneumonectomy for non-small cell lung cancer (10). Recently reported meta-analysis revealed that both neoadjuvant radiotherapy and chemoradiation therapy significantly increase the bronchopleural fistula risk but neoadjuvant chemotherapy does not (11). Moreover, in study of Asamura et al (1), the incidence of BPF after manual suture (4%) was higher than that after stapler suture (1%), but no significant difference was found.…”

Safety and effectiveness of localized lung resection combined with neoadjuvant chemotherapy in the treatment of stage I–II non-small cell lung cancer

“…Li et al (16) reported the results of neoadjuvant chemotherapy in the treatment of locally advanced NSCLC patients, and showed that the surgical resection rate significantly increased to 89.1%, intraoperative blood loss and operation time decreased, and the 3-year survival rate postoperatively significantly increased. Hu et al (17) administered neoadjuvant chemotherapy before radical resection of pulmonary carcinoma.…”