Postpneumonectomy bronchopleural fistula in non-small cell lung cancer patients: incidence, survival, mortality, and treatment analysis

Gürsoy, Soner; Yazgan, Serkan; Üçvet, Ahmet; Samancılar, Özgür; Ünal, Mehmet; Gülmez, Barış; Şirzai, Esra Yamansavci

doi:10.1007/s00595-018-1648-5

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…In pneumonectomy, the right main bronchus is wider and more vertical than the left, resulting in greater accumulation of secretions in the bronchial stump. 18) The left main bronchial stump tends to be under the cover of the aortic arch, whereas the right main bronchus is not covered with mediastinal tissue and therefore more likely to be exposed to the thoracic free space. In addition, the right bronchus is supplied with only one bronchial artery, whereas the left bronchus is supplied with two arteries.…”

Section: Discussionmentioning

confidence: 99%

“…19) If the single artery of the right bronchus is damaged during lymphadenectomy, the right bronchial stump becomes ischemic. 18,20) The above factors may also account for the high incidence of postoperative BPF after middle lower lobectomy. In the case of right lower lobectomy, preserving the middle lobe bronchus makes the distance from the bifurcation to the stump longer, possibly rendering it more ischemic than the left.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer

Tokunaga

Kita

Okamoto

2020

ATCS

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Purpose: Bronchopleural fistula (BPF) is a potential serious complication of lobectomy or more radical surgery for non-small-cell lung cancer (NSCLC). We aimed to evaluate the risk factors for BPF. Methods: The study cohort comprised 635 patients who had undergone lobectomy or more radical surgery for NSCLC from March 2005 to December 2017. We examined the following risk factors for BPF: surgical procedure, medical history, preoperative treatment, and surgical management. Results: In all, 10 patients (1.6%) had developed postoperative BPFs. Univariate logistic regression analysis showed that surgical procedure, medical history (arteriosclerosis obliterans [ASO]), and bronchial stump reinforcement were significant risk factors. Multivariate analysis showed that only surgical procedure (right lower lobectomy, p = 0.011, odds ratio = 17.4; right middle lower lobectomy, p = 0.003, odds ratio = 59.4; right pneumonectomy, p <0.001, odds ratio = 166.0) was a significant risk factor. Multivariate analysis confined to the surgical procedure of lobectomy showed that right lower lobectomy (p = 0.011, odds ratio = 36.5) and diabetes (HbA1c ≥8.0) (p = 0.022, odds ratio = 31.7) were significant risk factors. Conclusion: When lobectomy or more radical surgery is performed for NSCLC, right lower lobectomy, middle lower lobectomy, and right pneumonectomy are significant risk factors for postoperative BPF. Thoracic surgeons should acquire the techniques of bronchoplasty and angioplasty to avoid such invasive procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer

Tokunaga

Kita

Okamoto

2020

ATCS

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“…Similarly, Right pneumonectomy is a major risk factor for PP-BPF as the stump is more exposed than the left sided operation (12,13). Gursoy and colleagues summarized a number of case series and quote the incidence of BPF is between 0% and 6.3% after left pneumonectomy, but between 1.1% and 22.9% after right pneumonectomy (14). One explanation for this difference lies in the anatomical variation between left and right.…”

Section: Aetiologymentioning

confidence: 99%

“…Pre-operative empyema significantly increases risk of BPF (17). Furthermore, previous infection with tuberculosis at any point increases chances of PP-BPF (14). An already damaged and fibrotic bronchus/surrounding lung would understandably undermine any attempts at closure.…”

Section: Aetiologymentioning

confidence: 99%

Complications of thoracic surgery: post-pneumonectomy bronchopleural fistula

Wali¹,

Billè²

2021

Shanghai Chest

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Bronchopleural fistula (BPF) describes an abnormal connection between a bronchus (main, lobar or segmental) and the pleural cavity. BPF is a recognized complication after pneumonectomy and is associated with significant morbidity and mortality. The risk of post-pneumonectomy BPF (PP-BPF) is greater in right sided operations, male patients, residual tumor, barotrauma, previous TB and active infection. If suspected, diagnosis of BPF should be made expeditiously with computed tomography scanning and bronchoscopy. The management depends on the timing of presentation, the size of the fistula and the clinical status of the patient. All patients require drainage of the infected pleural space and intravenous antibiotics. In early presentations, re-do thoracotomy followed by stump closure and reinforcement with a pedicled muscle flap is recommended. If the fistula is small (<5 mm) or the patient is not fit enough for major surgery, bronchoscopic repair using fibrin glue application, stents or closure devices can be attempted. Minimally invasive techniques can also be used as a temporizing measure while optimizing a patient for a major intervention. There are multiple case reports describing novel bronchoscopic techniques for management of BPF. The risk of BPF should be reduced in high-risk patient groups by implementing bronchial stump coverage (BSC) at the time of pneumonectomy. Overall, the literature is limited by the relative rarity of the problem. Much of the literature is based on retrospective studies and case series which leads to inherent biases preventing true comparative studies in operative techniques and outcomes. Metaanalysis of case reports and new randomized controlled trials may give more evidence to support the current findings. While some simple principles should be followed, management of BPF needs to be individualized to each patient's clinical picture.

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“…Some studies have reported that compared with routine lobectomy, the incidence of BPF after bronchoplasty is higher (7,8). Several risk factors have been reported to be associated with BPF after lung surgery, such as diabetes mellitus (9)(10)(11), neoadjuvant therapy (11)(12)(13)(14)(15), right pneumonectomy, and right lower lobectomy (3,8,9,(16)(17)(18). However, few studies have focused on the risk factors for BPF after bronchoplasty.…”

Section: Introductionmentioning

confidence: 99%

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 in non-small cell lung cancer patients: incidence, survival, mortality, and treatment analysis

Cited by 15 publications

References 17 publications

Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer

Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer

Complications of thoracic surgery: post-pneumonectomy bronchopleural fistula

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

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