Postoperative Ischemic Bronchitis After Lymph Node Dissection and Primary Lung Cancer Resection

Benhamed, Lotfi; Bellier, Jocelyn; Fournier, C.; Akkad, R.; Mathieu, Daniel; Kipnis, Éric; Porte, Henri

doi:10.1016/j.athoracsur.2010.09.021

Cited by 23 publications

(22 citation statements)

References 16 publications

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“…Interesting results in our study were that seven out of eight patients developed bronchopleural fistulas after lobectomies, and only one after pneumonectomy. This fact was incompatible with previous reports, as the incidence of bronchopleural fistula was obviously higher after pneumonectomy for various reasons 6,8 . This might be explained in that were far fewer patients who underwent pneumonectomy during this period, than those who underwent lobectomies.…”

Section: Discussioncontrasting

confidence: 69%

“…Moreover, six out of seven patients who were classified N 2 postoperatively had bulky N 2 disease, and received more extensive dissection around the main bronchus with potential devascularization of the bronchial stump. Local ischemia following extensive lymph node dissection might be one of the causes of wound‐healing failure at the bronchial stump, leading to the development of bronchopleural fistulas 8 . Interesting results in our study were that seven out of eight patients developed bronchopleural fistulas after lobectomies, and only one after pneumonectomy.…”

Section: Discussionmentioning

confidence: 60%

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Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non‐small cell lung cancer

et al. 2013

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Background: Bronchopleural fistula is an especially severe complication with a high mortality rate. We investigated the efficiency of our surgical treatments for this severe complication. Methods: From January 2007 to December 2009, standard surgical resections and systematic lymph node dissections for non‐small cell lung cancer (NSCLC) were performed on 1178 patients at our institution. Eight patients developed bronchopleural fistulas during the postoperative follow‐up period, and received reoperations. Seven patients underwent additional pneumonectomies, and the omental flap, which was mobilized using a transdiaphragmatic harvesting technique through the usual thoracotomy, was used to cover postpneumonectomy bronchial stump. The other patient, who had received right side pneumonectomy and systemic lymph node dissection, received omental flap stuffing and covering without reclosure of the stump or carinal plasty. Results: Bronchopleural fistulas after standard surgical resections and systematic lymph node dissections for NSCLC were observed in eight patients (0.68%) in our study. The period between pulmonary resection and the appearance of bronchopleural fistula ranged from eight to 19 days (median 11 days). Repairing of the bronchial fistula was successful in all eight patients and no development of late fistula was found during the follow‐up period. Postoperative hospital stay for undergoing omentoplasty to repair the bronchial fistula ranged between 11 and 23 days (median 15 days). There were no complications related to the omentoplasty procedure. Conclusion: Transdiaphragmatic harvesting technique of omental flap through a thoracotomy is safe and technically feasible. Surgical treatment for postoperative bronchopleural fistula with omental flap covering is effective.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 60%

Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non‐small cell lung cancer

et al. 2013

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“…In one study, HOT was beneficial in the management of ischemic bronchitis. In that study, 28 (62.4%) of the 34 included ischemic bronchitis patients were cured; all of them had been treated with HOT [8]. No patients presented with any adverse effects.…”

Section: Commentmentioning

confidence: 89%

Conservatively Treated Extended Tracheal Necrosis Complicating Pharyngolaryngectomy

Wolf¹,

Fournier²,

Surmei³

et al. 2015

The Annals of Thoracic Surgery

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“…In general, new vascularization develops after creating the anastomosis from the recipient to the donor tissue. However, in the case of IMF coverage of the bronchial stump, the development of new blood vessels and increased blood circulation from the bronchus to the IMF are not expected because the blood supply of the bronchial stump itself is poor as a result of lymph node dissection or bronchoplasty . Therefore, the blood supply of the IMF used to reinforce the bronchial stump should be ensured intraoperatively .…”

Section: Discussionmentioning

confidence: 99%

“…of IMF coverage of the bronchial stump, the development of new blood vessels and increased blood circulation from the bronchus to the IMF are not expected because the blood supply of the bronchial stump itself is poor as a result of lymph node dissection or bronchoplasty. [27][28][29] Therefore, the blood supply of the IMF used to reinforce the bronchial stump should be ensured intraoperatively. 30 In this study, the part of the muscle flap with the best blood supply was selectively used to reinforce the bronchial stump.…”

Section: Figurementioning

confidence: 99%

Indocyanine green fluorescence/thermography evaluation of intercostal muscle flap vascularization

et al. 2018

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BackgroundDuring anatomical lung resection in high‐risk patients, the bronchial stump is covered with tissue flaps (e.g. pericardial fat tissue and intercostal muscle) to prevent bronchopleural fistula development. This is vital for reliable reinforcement of the bronchial stump. We evaluated the blood supply of the flap using indocyanine green fluorescence (ICG‐FL) and thermography intraoperatively in 27 patients at high risk for developing a bronchopleural fistula.MethodsBefore reinforcing the stump with a flap, the fluorescence agent was intravenously injected and the blood supply was evaluated. The surface temperature of the flap was measured with thermography. The two modalities were then compared.ResultsICG‐FL intensity and surface temperature on the distal compared to the proximal side of the flap decreased by 32.6 ± 29.4% (P < 0.0001) and 3.5 ± 2.0°C (P < 0.0001), respectively. In patients with a higher ICG‐FL intensity value at the tip than the median, the surface temperature at the tip decreased by 2.7 ± 1.7°C compared to the proximal side. In patients with a lower ICG‐FL value at the tip, the surface temperature decreased by 4.6 ± 1.7°C (P = 0.0574). The bronchial stump reinforced the part of the flap with adequate blood supply; none of the patients developed a bronchopleural fistula.ConclusionsICG‐FL confirmed variation in the blood supply of the intercostal muscle flap, even if prepared using the same surgical procedure. Thermography analysis tends to correlate with the fluorescence method, but may be influenced by the state of flap preservation during surgery.

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Postoperative Ischemic Bronchitis After Lymph Node Dissection and Primary Lung Cancer Resection

Cited by 23 publications

References 16 publications

Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non‐small cell lung cancer

Surgical treatment for bronchopleural fistula with omentum covering after pulmonary resection for non‐small cell lung cancer

Conservatively Treated Extended Tracheal Necrosis Complicating Pharyngolaryngectomy

Indocyanine green fluorescence/thermography evaluation of intercostal muscle flap vascularization

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