The Rationale for Treatment of Postresectional Bronchopleural Fistula: Analysis of 52 Patients

Cardillo, Giuseppe; Carbone, Luigi; Carleo, Francesco; Galluccio, Giovanni; Martino, Marco; Giunti, Roberto; Lucantoni, Gabriele; Battistoni, Paolo; Batzella, Sandro; Iacono, Raffaele Dello; Petrella, Lea; Dusmet, Michael

doi:10.1016/j.athoracsur.2015.03.014

Cited by 58 publications

(73 citation statements)

References 27 publications

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“…Reoperation was saved in half of the patients with BPF. The result suggested that postoperative care of patients at high-risk of BPF must include close monitoring and urgent intervention to avoid surgical intervention for BPF [22].…”

Section: Prevention Of Bpfmentioning

confidence: 99%

Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan

Endo

Ikeda

Kondo

et al. 2018

Gen Thorac Cardiovasc Surg

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Background Broncho-pleural fistula (BPF) and respiratory failure (RF) are life-threatening complications after lung cancer surgery and can result in long-term hospitalization and decreased quality of life. Risk assessments for BPF and RF in addition to mortality and major morbidities are indispensable in surgical decision-making and perioperative care. Methods The characteristics and operative data of 80,095 patients who had undergone lung cancer surgery were derived from the 2014 and 2015 National Clinical Database (NCD) of Japan datasets. After excluding 1501 patients, risk models were developed from these data and validated by another dataset for 42,352 patients derived from the 2016 NCD dataset. Receiver operating characteristic curves were generated for postoperative BPF and RF development. The concordance-index was used to assess the discriminatory ability and validity of the model. Results BPF and RF occurred in 259 (0.3%) and 420 patients (0.5%), respectively, in the model development dataset and in 129 (0.3%) and 198 patients (0.5%), respectively, in the model validation dataset. Characteristic variables including types of surgery and comorbidities were identified as risk factors for BPF and RF, respectively. The concordance indexes of assessments for BPF and RF were 0.847 (p < 0.001) and 0.848 (p < 0.001), respectively, for the development dataset and 0.850 (p < 0.001) and 0.844 (p < 0.001), respectively, for the validation dataset. Conclusions These models are satisfactory for predicting BPF and RF after lung cancer surgery in Japan and could guide preoperative assessment and optimal measures for preventing BPF and RF.

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Section: Prevention Of Bpfmentioning

confidence: 99%

Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan

Endo

Ikeda

Kondo

et al. 2018

Gen Thorac Cardiovasc Surg

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“…Endoscopic management is primarily diagnostic, but now therapeutic as well is a bridge to definitive surgery. [28][29][30] The main benefit of VATS are better visualisation, which allow secure fixation of vascularised graft and decreased retraction of thoracic cage so postoperative pain is less and morbidity is reduced.…”

Section: Discussionmentioning

confidence: 99%

Dead Space Reduction Closed Thoracoplasty in Chronic Empyema Thoracis Patients of Early Young Age Group

Sharma¹,

Gupta²,

Kaushal³

et al. 2018

jemds

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BACKGROUNDThe social stigma of chronic empyema thoracis treated with open window thoracostomy (OWT) has significant negative impact on psychosocial well-being, especially in early young age group patients. So, evaluation of better alternative of dead space reduction closed thoracoplasty method was done by the author. Aims and Objectives-To evaluate standard easily reproducible surgical method to cure and control chronic empyema thoracis other than open window thoracostomy in early young age group patients in central India. MATERIALS AND METHODSDead space reduction closed thoracoplasty was performed in 44 patients of chronic empyema thoracis between the age group of 13 and 25 years by conventional thoracoplasty (Alexander type), tailoring thoracoplasty and Schede thoracoplasty. Patients were evaluated in terms of weight gain, chest x-ray, air leak and column movement in ICD and pus culture sensitivity at regular intervals. Targeted dead space reduction is achieved excellently when column movement is less than 5 cm and acceptable when between 5 and 10 cm. Absence of air leak even on coughing (excellent) and only on coughing (acceptable) in patent intercostal drainage tube. Statistical Analysis-By student's t-test, repeated measure ANOVA test for difference of mean, confidence interval with standard error estimation, 'p' value and percentage also. Setting and Design-A hospital-based prospective longitudinal study as all the enrolled patients are followed up at designed time. RESULTSChronic empyema thoracis of 40 patients was cured and controlled with dead space reduction thoracoplasty, whereas 4 patients with multi-drug resistance tuberculosis (MDR TB) did not cure, so they further required other modalities. CONCLUSIONPatients with persistent infection and poor weight gain have high failure rate in dead space reduction closed thoracoplasty.

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“…In this case series, the endoscopic procedure was safe and cost-saving, and in contrast to stents or coils, the authors showed that BPF closure was obtained by a local reactive inflammatory response from the cellulose patch [6]. Although several studies report the success of sealant glues in the treatment of smaller BPF, a higher failure rate has been well documented in the presence of BPF of 5 mm or larger [5,6,9,10]. The failure of sealing compounds in large fistulae can be due to insufficient stability in the lesion resulting in the expectoration of the plug.…”

Section: Discussionmentioning

confidence: 99%

“…A “chronic fistula” was defined as a postoperative complication without life-threatening event [1,2]. Patients with smaller air leaks treated conservatively have been described in a previous study and were excluded [5]. All the procedures were performed with a Dumon rigid bronchoscope (Efer Medical, Cedex, France) under intravenous deep sedation with short-acting narcotics and benzodiazepines.…”

Section: Methodsmentioning

confidence: 99%

The Use of Polyvinyl Alcohol Sponge and Cyanoacrylate Glue in the Treatment of Large and Chronic Bronchopleural Fistulae following Lung Cancer Resection

et al. 2017

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Background: Bronchopleural fistulae represent a relatively rare complication of pulmonary resection. For inoperable patients, several endoscopic procedures have been described. In the presence of large and chronic bronchopleural fistulae, persistent air leaks require a surgical therapy, while endoscopic airway stent represents a useful palliative treatment. Objective: We describe the successful closure of large and chronic bronchopleural fistulae using an expandable polyvinyl alcohol (PVA) sponge and cyanoacrylate glue. Methods: In all patients, a rigid bronchoscope was used to insert a small cylinder of PVA sponge within the fistula. After releasing the patch, cyanoacrylate glue was applied directly on the PVA sponge using a channel catheter. This methodology induces an expansion of the clot and the closure of the air leak. The long-term outcome of treatment was checked by flexible bronchoscopy once every month for 3 months and every 6 months until 5 years. Results: We performed endoscopic treatment in 7 consecutive patients with bronchopleural fistula ranging from 4 to 8 mm. In 6 of 7 patients, the bronchial stump was the site of the fistula. In 1 patient, the fistula was visualized on the right wall of the distal trachea. A temporary complete occlusion of the fistula was achieved in 7 of 7 patients and a definitive result in 5 of 7 patients. Conclusions: The use of an expandable PVA sponge and cyanoacrylate glue is an available strategy for endobronchial closure of bronchopleural fistulae.

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The Rationale for Treatment of Postresectional Bronchopleural Fistula: Analysis of 52 Patients

Cited by 58 publications

References 27 publications

Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan

Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan

Dead Space Reduction Closed Thoracoplasty in Chronic Empyema Thoracis Patients of Early Young Age Group

The Use of Polyvinyl Alcohol Sponge and Cyanoacrylate Glue in the Treatment of Large and Chronic Bronchopleural Fistulae following Lung Cancer Resection

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