1
|
Solak N, Çetin M, Can MA, Gürçay N, Gülhan SŞE, Aydoğdu K, Fındık G, Bıçakçıoğlu P. Are precautions actually a risk factor in the development of bronchopleural fistula after pneumonectomy? A retrospective analysis of 299 cases. Updates Surg 2024:10.1007/s13304-024-01772-z. [PMID: 38494568 DOI: 10.1007/s13304-024-01772-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE Bronchopleural fistula most commonly occurs after pneumonectomies, with high morbidity and mortality. A preventive approach is essential. Risk factors can be classified depending on the patient, anatomy, surgical technique, and other causes. METHODS Patients (n = 370) who underwent pneumonectomy between 2010 and 2020 were evaluated. The digital media and archive files of the patients (n = 299) were reviewed retrospectively. RESULTS While 271 patients (90.6%) were male, 28 (9.4%) were female. The mean age was 56.63 years. The bronchopleural fistula rate was 14.7% (44/299). Serum protein deficiency, right pneumonectomy, completion pneumonectomy, bronchial manual suturing, advanced stage, prolongation of time after neoadjuvant therapy, length of drain and hospital stay, tissue support for the stump, and short bronchial stump were significant for bronchopleural fistula. Smoking in patients operated on for malignancy and low serum albumin value in benign and chronic infectious diseases were significant in terms of fistula. In patients who developed bronchopleural fistula, the 5-year survival rate was 18.4%. CONCLUSION The most important risk factors in bronchopleural fistula depend on the surgical technique and so are completely preventable. Contrary to the literature, short stump and tissue support to the stump were found to be risk factors for fistula. In addition, the effect of the time between neoadjuvant therapy and operation should be examined in further studies.
Collapse
Affiliation(s)
- Necati Solak
- Department of Thoracic Surgery, Sincan Training and Research Hospital, Ankara, Turkey.
| | - Mehmet Çetin
- Department of Thoracic Surgery, Etlik City Hospital, Ankara, Turkey
| | - Mehmet Ali Can
- Department of Radiology, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Nesrin Gürçay
- Department of Pathology, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | | | - Koray Aydoğdu
- Department of Thoracic Surgery, Etlik City Hospital, Ankara, Turkey
| | - Göktürk Fındık
- Department of Thoracic Surgery, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Pınar Bıçakçıoğlu
- Department of Thoracic Surgery, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
2
|
Wang QY, Cheng M, Ban CJ, Zhang LS, Wang HW, Yang B, Zou H, Wang MZ. Integrated Chinese and Western Medicine in Treatment of Bronchopleural Fistula with Mycobacterium abscessus: A Case Report. Chin J Integr Med 2023:10.1007/s11655-023-3605-4. [PMID: 38157117 DOI: 10.1007/s11655-023-3605-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Qian-Yun Wang
- The First Clinical Medical College of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Miao Cheng
- Department of Respiratory, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Cheng-Jun Ban
- Department of Respiratory, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Li-Shan Zhang
- Department of Respiratory, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Hong-Wu Wang
- Department of Respiratory, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Bing Yang
- Department of Respiratory, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
| | - Heng Zou
- Department of Respiratory, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Ming-Zhe Wang
- Department of Respiratory, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| |
Collapse
|
3
|
Korymasov EA, Medvedchikov-Ardiya MA, Polyakov IS, Benyan AS. [Staged reconstructive surgery for bronchopleural fistula]. Khirurgiia (Mosk) 2023:61-65. [PMID: 37850896 DOI: 10.17116/hirurgia202304161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Treatment of bronchopleural fistula after pneumonectomy is still an urgent problem for thoracic surgeons. Transsternal bronchial stump occlusion should be preferable if possible. However, this is not enough for curing in some cases. We present a patient with concomitant cancer and tuberculosis of lungs whose postoperative period was complicated by bronchial stump failure. Preoperative diagnostic data are presented. We describe the indications for surgeries and main surgical stages. Some interventions including reconstructive surgery using a muscle flap led to recovery. Latissimus dorsi muscle flap on thoracodorsal artery is the best option for reconstructive surgical treatment in patients with extensive chest wall defects and thoracostomy.
Collapse
Affiliation(s)
- E A Korymasov
- Samara State Medical University, Samara, Russia
- Seredavin Samara Regional Clinical Hospital, Samara, Russia
| | | | - I S Polyakov
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A S Benyan
- Samara State Medical University, Samara, Russia
| |
Collapse
|
4
|
Geyik FD, Dogruyol T, Kahraman S, Arslan G, Saracoglu KT, Demirhan R. Short-Term Outcomes of Fiberoptic Bronchoscopy-guided Resection and Anastomosis Control in Thoracic Surgery. Surg Laparosc Endosc Percutan Tech 2022; 32:673-676. [PMID: 36223315 DOI: 10.1097/sle.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In thoracic surgery practice, bronchial closure and anastomosis are relatively easy in technical terms; however, it is also the procedure that is most open to the development of complications with high morbidity. This study aimed to investigate the effect of simultaneous evaluation of bronchial closure under fiberoptic bronchoscopy guidance during lung resection on the development of complications. MATERIALS AND METHODS Patients aged over 18 years who underwent elective lung resection in our clinic between 2017 and 2021 were included in the study. Postoperative complications were recorded and statistically analyzed. RESULTS The mean age of the patients was 61.4±10.4 years, and 267 patients were male (75.4%) and 87 (24.6%) were female. Thoracotomy was performed in 258 (72.9%) patients and lung resection with the video-assisted thoracoscopic surgery technique in 96 (27.1%) patients. During the follow-up, complications were observed during the first 30 days in 78 (22.0%) of the patients and later in 9 (2.5%). Surgical mortality occurred in 11 patients (3.1%), and the rate of readmission to the intensive care unit was 5.6% (n=20). CONCLUSION We consider that the control of the resection line with the active use of fiberoptic bronchoscopy during surgery is important for the prevention of the development of bronchial morbidity. Complications in the early period can be reduced by ensuring that the remaining bronchus is not narrowed, there are no residual stump structures that may disrupt the bronchial line, such as cartilage, and bronchial washing is frequently undertaken.
Collapse
Affiliation(s)
- Fatih Dogu Geyik
- Department of Anesthesiology and Reanimation, Kartal Dr Lutfi Kirdar City Hospital
| | | | | | - Gulten Arslan
- Department of Anesthesiology and Reanimation, Kartal Dr Lutfi Kirdar City Hospital
| | | | | |
Collapse
|
5
|
Djouani A, Hurley P, Lampridis S, Bille A. Successful Closure of Post-pneumonectomy Bronchopleural Fistula With Suture Repair Reinforced With Porcine Acellular Dermal Matrix (Permacol) and Hydrogel Sealant (Progel): A Case Report. Cureus 2022; 14:e28529. [PMID: 36185841 PMCID: PMC9517695 DOI: 10.7759/cureus.28529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/15/2022] Open
Abstract
Bronchopleural fistula (BPF) is a feared and potentially life-threatening complication of pneumonectomy. Clinical features such as a productive cough and subcutaneous emphysema raise suspicion of BPF with CT imaging and bronchoscopy providing a definitive diagnosis. In light of the significant morbidity and mortality associated with the condition, a significant proportion of cases necessitate surgical repair of the bronchial stump. Currently, there is no consensus on optimal surgical strategy. Traditionally, various vascularised tissue flaps, including pericardial fat pad, omentum, and muscle, have been used to buttress the repaired stump, with varying success rates. In light of this, novel approaches have been devised with the aim of achieving more consistent surgical outcomes. In this case report, we describe a novel approach to reinforcing the suture repair using porcine dermal collagen matrix (Permacol, Medtronic, Minneapolis, MN) and hydrogel sealant (Progel, BD, Franklin Lakes, NJ) to achieve successful closure of a BPF in an adult male patient following pneumonectomy for squamous cell carcinoma. The use of porcine dermal collagen matrix covered with hydrogel sealant is a viable alternative to traditional BPF closure strategies and can achieve good patient outcomes. This technique has several benefits including cost-effectiveness and sparing of native tissues, and it is technically straightforward. Further studies are required to compare the clinical outcomes of this and other novel techniques with traditional BPF closure approaches.
Collapse
|
6
|
Dell’Amore A, Campisi A, De Franceschi E, Bertolaccini L, Gabryel P, Chen C, Ciarrocchi AP, Russo MD, Cannone G, Fang W, Piwkowski C, Spaggiari L, Rea F. Surgical results of non-small cell lung cancer involving the heart and great vessels advanced lung cancer surgically treated. Eur J Surg Oncol 2022; 48:1929-1936. [DOI: 10.1016/j.ejso.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/22/2022] [Accepted: 02/06/2022] [Indexed: 10/19/2022] Open
|
7
|
Tokunaga Y, Kita Y, Okamoto T. Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer. Ann Thorac Cardiovasc Surg 2020; 26:311-319. [PMID: 32224595 PMCID: PMC7801181 DOI: 10.5761/atcs.oa.20-00010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Yoshimasa Tokunaga
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
| | - Yusuke Kita
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
| | - Taku Okamoto
- Department of General Thoracic Surgery, Kochi Health Sciences Center, Kochi, Kochi, Japan
| |
Collapse
|
8
|
Muthu V, Prasad KT, Agarwal R. Postoperative bronchopleural fistula: Does one size fit all? Lung India 2020; 37:97-99. [PMID: 32108591 PMCID: PMC7065545 DOI: 10.4103/lungindia.lungindia_89_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|