Variation in incidence, prevention and treatment of persistent air leak after lung cancer surgery

Hoeijmakers, Fieke; Hartemink, Koen J.; Steup, W. H.; Marra, Emanuele; Roell, Wilhelm; Heineman, David J.; Schreurs, W. H.; Tollenaar, Rob A.E.M.; Wouters, Michel W. J. M.

doi:10.1093/ejcts/ezab376

Cited by 16 publications

(15 citation statements)

References 24 publications

(20 reference statements)

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“…8 Persistent air leak after lung surgery or radiological interventions has also been successfully treated with endobronchial valves. [9][10][11] Persistent air leak related to SARS-CoV-2 infection has successfully been treated with endobronchial valve placement. 12 Figure 1 (A-F).…”

Section: Discussionmentioning

confidence: 99%

“…However, the development of pneumatoceles is reported also to be induced by the insertion of endobronchial valves 8. Persistent air leak after lung surgery or radiological interventions has also been successfully treated with endobronchial valves 9–11. Persistent air leak related to SARS-CoV-2 infection has successfully been treated with endobronchial valve placement 12…”

Section: Discussionmentioning

confidence: 99%

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Treatment of a pneumatocele in a COVID-19 patient with endobronchial valves

et al. 2022

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A man in his 40s was admitted to his local hospital 6 days after the first vague symptoms of COVID-19. His general condition deteriorated, and he was treated in the intensive care unit but did not require mechanical ventilation. During his recovery, he experienced a cough spell, after which his dyspnoea recurred and rapidly increased. CT pulmonary angiogram showed a 10×18 cm cavitary lesion with an air-fluid level and surrounding atelectasis of the right lower lobe. A one-way valve mechanism had developed, leading to the formation of a pneumatocele. The patient was treated by occlusion of all bronchial segments of the right lower lobe with endobronchial valves, and the pneumatocele was evacuated with a pigtail catheter. The valves were removed 4 weeks after insertion, and the right lower lobe re-expanded. Six months after treatment, the patient had recovered completely and almost regained his former lung function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of a pneumatocele in a COVID-19 patient with endobronchial valves

et al. 2022

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“…We have used large diameter chest tubes instead of relatively smaller chest tubes in the past few years, mainly because once a large amount of pulmonary alveolar or small bronchiolar fistulas appeared, we were concerned smaller chest tubes would not offer adequate air drainage that exceeded the speed of pulmonary alveolar fistula, thus air could penetrate the muscles of the wound and subsequently form subcutaneous emphysema (28). The majority of cases of subcutaneous emphysema can resolve on their own, though it can cause panic and discomfort among these patients, therefore prolonging their hospital time (29,30). Nevertheless, conventional chest tubes can also lead to several problems, such as intercostal nerve pain, poor incision healing, and high thoracic drainage volume that can potentially cause massive nutritional loss.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of multi-groove silicone drains in single-port video-assisted thoracoscopic lung cancer surgery and their effect on C-reactive protein: a single-center experience

et al. 2021

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Background: The purpose of this study was to systematically evaluate the effectiveness and safety of a multi-groove silicone drain in single-port video-assisted thoracoscopic lung cancer surgery and its effect on postoperative serum C-reactive protein (CRP) levels. Methods: We retrospectively analyzed 122 surgical cases who underwent standard lobectomy and lymph node dissection for primary lung cancer between May 2020 and December 2020. A total of 62 patients received 19-F multi-groove silicone drains (experimental group) and 60 patients received 24-F conventional chest drains (control group). According to the different thoracic drainage approaches, the clinical efficacy in the perioperative period, postoperative complications, and postoperative serum CRP levels were compared between the 2 groups. Results: In this study, thoracic drainage volume, the average visual analog scale (VAS) pain scores in incisions, the rate of primary healing at the site of incisions, and the pulmonary infection rate in the multigroove silicone drain group were significantly lower than those in the conventional chest drain group (P<0.05), but there was no significant difference in the average hospital stay time, arrhythmia rates, and chest tube removal time between the 2 groups. At postoperative day 1, the levels of serum CRP in the 2 groups were further increased (P>0.05), and the comparison between the 2 groups showed that the levels of serum CRP in the multi-groove silicone drain group at 72 h after the operation were significantly lower than those in the conventional drain group (P<0.05). Conclusions:Our results showed that a multi-groove silicone drain is feasible and relatively safe in singleport video-assisted thoracoscopic lung cancer surgery for most patients. However we should take cautious in those patients with higher susceptibility of postoperative active bleeding. In patients undergoing lung cancer surgery in the clinical treatment process, the use of a multi-groove silicone drain can improve the quality of life of patients. Due to a small number of included studies and unclear bias, the above results should be verified by high-quality, large-sample randomized controlled studies.

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“…At present, many risk factors have been identified to increase the incidence of postoperative PAL, including male sex, low body mass index (BMI), smoking history, reduced percentage of the predicted value for forced expiratory volume in 1 second (FEV1% predicted), previous chemoradiotherapy, presence of diabetes and lobectomy [ 5 , 6 , 11 ]. Although a few predictive models for stratifying patients with high risk for PAL have been developed in recent years [ 12 – 18 ], there is still no standard model to estimate the incidence of PAL.…”

Section: Introductionmentioning

confidence: 99%

Construction and validation of a nomogram for predicting prolonged air leak after minimally invasive pulmonary resection

Xue

et al. 2022

World J Surg Onc

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Background Prolonged air leak (PAL) remains one of the most frequent postoperative complications after pulmonary resection. This study aimed to develop a predictive nomogram to estimate the risk of PAL for individual patients after minimally invasive pulmonary resection. Methods Patients who underwent minimally invasive pulmonary resection for either benign or malignant lung tumors between January 2020 and December 2021 were included. All eligible patients were randomly assigned to the training cohort or validation cohort at a 3:1 ratio. Univariate and multivariate logistic regression were performed to identify independent risk factors. All independent risk factors were incorporated to establish a predictive model and nomogram, and a web-based dynamic nomogram was then built based on the logistic regression model. Nomogram discrimination was assessed using the receiver operating characteristic (ROC) curve. The calibration power was evaluated using the Hosmer-Lemeshow test and calibration curves. The nomogram was also evaluated for clinical utility by the decision curve analysis (DCA). Results A total of 2213 patients were finally enrolled in this study, among whom, 341 cases (15.4%) were confirmed to have PAL. The following eight independent risk factors were identified through logistic regression: age, body mass index (BMI), smoking history, percentage of the predicted value for forced expiratory volume in 1 second (FEV1% predicted), surgical procedure, surgical range, operation side, operation duration. The area under the ROC curve (AUC) was 0.7315 [95% confidence interval (CI): 0.6979–0.7651] for the training cohort and 0.7325 (95% CI: 0.6743–0.7906) for the validation cohort. The P values of the Hosmer-Lemeshow test were 0.388 and 0.577 for the training and validation cohorts, respectively, with well-fitted calibration curves. The DCA demonstrated that the nomogram was clinically useful. An operation interface on a web page (https://lirongyangql.shinyapps.io/PAL_DynNom/) was built to improve the clinical utility of the nomogram. Conclusion The nomogram achieved good predictive performance for PAL after minimally invasive pulmonary resection. Patients at high risk of PAL could be identified using this nomogram, and thus some preventive measures could be adopted in advance.

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Variation in incidence, prevention and treatment of persistent air leak after lung cancer surgery

Cited by 16 publications

References 24 publications

Treatment of a pneumatocele in a COVID-19 patient with endobronchial valves

Treatment of a pneumatocele in a COVID-19 patient with endobronchial valves

Efficacy of multi-groove silicone drains in single-port video-assisted thoracoscopic lung cancer surgery and their effect on C-reactive protein: a single-center experience

Construction and validation of a nomogram for predicting prolonged air leak after minimally invasive pulmonary resection

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