1
|
Habu T, Yamamoto H, Nakata K, Hashimoto K, Tanaka S, Shien K, Suzawa K, Miyoshi K, Okazaki M, Sugimoto S, Toyooka S. Prophylactic effect of tissue flap in the prevention of bronchopleural fistula after surgery for lung cancer. Surg Today 2024:10.1007/s00595-024-02927-6. [PMID: 39196340 DOI: 10.1007/s00595-024-02927-6] [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: 04/01/2024] [Accepted: 07/19/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Bronchopleural fistula (BPF) is a serious complication of lung resection. To avoid BPF, the bronchial stump/anastomotic site is often covered with a flap of surrounding tissue. One risk factor for BPF is radical lung resection after induction chemoradiotherapy for lung cancer. We retrospectively reviewed our database to elucidate the characteristics of tissue flaps that prevent BPF. METHODS This retrospective study included 152 patients treated between 1999 and 2019. We examined the clinicopathological characteristics, including the type and thickness of the tissue flap used to cover the bronchial stump/anastomotic site, and postoperative complications, including BPF. RESULTS BPF occurred in 5 patients (3.3%). All 5 patients had complications that could have affected delayed wound healing, such as pneumonia. The covering tissue flap thickness was significantly greater in patients without BPF than in those who developed BPF (p = 0.0290). Additionally, the tissue flap thickness was significantly greater than in those with BPF (p = 0.0077), even in high-risk patients who developed pneumonia or radiation pneumonitis on the operative side within 6 months postoperatively. CONCLUSION Perioperative management is crucial to avoid complications affecting the healing of the bronchial stump/anastomotic site, and the covering tissue flap thickness may be an important factor in avoiding or minimizing BPF.
Collapse
Affiliation(s)
- Tomohiro Habu
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hiromasa Yamamoto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
- Center for Clinical Genetics and Genomic Medicine, Shimane University Hospital, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Kentaro Nakata
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Kohei Hashimoto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Shin Tanaka
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kazuhiko Shien
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Ken Suzawa
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Mikio Okazaki
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | | | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| |
Collapse
|
2
|
DePrez KN, Ferguson J. Endobronchial Infection and Bacterial Lymphadenitis by Gemella morbillorum Leading to Airway Perforation and a Bronchopleural Fistula. Case Rep Pulmonol 2024; 2024:8850287. [PMID: 39050968 PMCID: PMC11268966 DOI: 10.1155/2024/8850287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 04/21/2024] [Accepted: 06/17/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction: Necrotizing bronchial infection with severe infectious lymphadenitis is infrequently encountered and most commonly ascribed to Aspergillus, Histoplasma, and Mycobacterium species. We present a unique cause of severe airway destruction with lymphadenitis and bronchopleural fistula formation by the bacterium Gemella morbillorum. Case: A 24-year-old man presented with acute symptoms of vomiting, fever, and shoulder pain. A CT of the chest demonstrated a large subcarinal mass encasing the central bronchi. The workup for malignant, fungal, and granulomatous etiologies was unrevealing, while blood cultures identified G. morbillorum. Fiberoptic bronchoscopy revealed a perforation of the right middle lobar bronchus and the formation of a bronchopleural fistula, resulting in a large hydropneumothorax with empyema. Despite antibiotic therapy, surgical intervention to repair the fistula, and ventilatory support, the progression of the bronchopleural fistula led to fatal respiratory failure. Conclusion: In cases of severe mediastinal adenopathy in a young patient, bacterial lymphadenitis should be considered in the differential diagnosis with lymphoma, germ cell tumor, granulomatosis with polyangiitis, sarcoidosis, histoplasmosis, and inflammatory myofibroblastic tumor.
Collapse
Affiliation(s)
- Kaitlin N. DePrez
- College of Osteopathic MedicineRocky Vista University, 8401 S Chambers Rd, Englewood, Colorado 80112, USA
| | - John Ferguson
- Department of Internal MedicineRocky Mountain Pulmonary and Critical Care, 3555 Lutheran Pkwy, Suite 150, Wheat Ridge, Colorado 80033, USA
| |
Collapse
|
3
|
Wang YH, Huang HC, Lin FCF. Bronchoscopic management of bronchopleural fistula using free fat pad transplant with platelet-rich plasma: a case study. J Cardiothorac Surg 2024; 19:372. [PMID: 38918864 PMCID: PMC11197359 DOI: 10.1186/s13019-024-02900-x] [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: 02/09/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND A bronchopleural fistula (BPF) occurs when an abnormal connection forms between the bronchial tubes and pleural cavity, often due to surgery, infection, trauma, radiation, or chemotherapy. The outcomes of both surgical and bronchoscopic treatments frequently prove to be unsatisfactory. CASE PRESENTATION Here, we report a case of successful bronchoscopic free fat pad transplantation combined with platelet-rich plasma, effectively addressing a post-lobectomy BPF. Contrast-enhanced chest tomography revealed pleural thickening with heterogeneous consolidations over the right upper and middle lobes, indicative of destructive lung damage and bronchiectasis. The patient underwent thoracoscopic bilobectomy of the lungs. During surgery, severe adhesions and calcification of the chest wall and lung parenchyma were observed. The entire hilar structure was calcified, presenting challenges for dissection, despite the assistance of energy devices. Bronchoscopic intervention was required, during which two abdominal subcutaneous fat pads were retrieved. CONCLUSION This innovative approach offers promise in the management of BPF and signals potential advancements in enhancing treatment efficacy and patient recovery.
Collapse
Affiliation(s)
- Yu-Hsiang Wang
- Department of Surgery, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Hsu-Chih Huang
- Division of thoracic surgery depart, Chung Shan Medical University Hospital, 402 No. 110, Section 1, Jianguo North Road, Taichung City, Taiwan
- Chung Shan Medical University, Taichung City, Taiwan
| | - Frank Cheau-Feng Lin
- Division of thoracic surgery depart, Chung Shan Medical University Hospital, 402 No. 110, Section 1, Jianguo North Road, Taichung City, Taiwan.
- Chung Shan Medical University, Taichung City, Taiwan.
| |
Collapse
|
4
|
Iliocostalis Muscle Rotational Flap: A Novel Flap for Esophagopleural Fistula Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4007. [PMID: 35186613 PMCID: PMC8849421 DOI: 10.1097/gox.0000000000004007] [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] [Received: 08/23/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
Intrathoracic fistulas present major challenges to reconstructive surgeons. Reconstruction with muscle flaps have been shown to improve patient outcomes; however, there are patients for whom one or more of the commonly used muscle flaps is not available for several reasons. We describe the use of an iliocostalis muscle rotational flap for the repair of a caudally located esophagopleural fistula in the setting of definitive chemoradiotherapy for treatment of nonsmall-cell lung cancer and reirradiation with photons for local recurrence 5 years later. Our repair remained intact through the nearly 12-month follow-up period during which the patient tolerated a regular diet. This report demonstrates that the iliocostalis lumborum muscle is a viable option for repair of intrathoracic fistulas that are located in the distal esophagus, even in the setting of previous thoracotomy and radiation, and should be part of the reconstructive surgeon's armamentarium in the management of intrathoracic fistulas.
Collapse
|
5
|
Asaad M, Van Handel A, Akhavan AA, Huang TCT, Rajesh A, Shen KR, Allen MA, Sharaf B, Moran SL. Prophylactic Bronchial Stump Support With Intrathoracic Muscle Flap Transposition. Ann Plast Surg 2021; 86:317-322. [PMID: 33555686 DOI: 10.1097/sap.0000000000002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bronchopleural fistula (BPF) is a dreaded complication of pulmonary resection. For high-risk patients, bronchial stump coverage with vascularized tissue has been recommended. The goal of this study was to report our experience with intrathoracic muscle transposition for bronchial stump coverage. METHODS A retrospective review of all patients who underwent intrathoracic muscle flap transposition as a prophylactic measure at our institution between 1990 and 2010 was conducted. Demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS A total of 160 patients were identified. The most common lung resections performed were pneumonectomy (n = 69, 43%) and lobectomy (n = 60, 38%). A total of 168 flaps were used where serratus anterior was the most common flap (n = 136, 81%), followed by intercostal (n = 14, 8%), and latissimus dorsi (n = 12, 7%). Ten patients (6%) developed BPF, and empyema occurred in 13 patients (8%). Median survival was 20 months, and operative mortality occurred in 7 patients (4%). CONCLUSIONS Reinforcement of the bronchial closure with vascularized muscle is a viable option for potentially decreasing the incidence of BPF in high-risk patients. Further randomized studies are needed to determine the efficacy of this technique for BPF prevention.
Collapse
Affiliation(s)
- Malke Asaad
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | | | | | - Tony C T Huang
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | | | - K Robert Shen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Mark A Allen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Basel Sharaf
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| | - Steven L Moran
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic
| |
Collapse
|
6
|
Asaad M, Van Handel A, Akhavan AA, Huang TTC, Rajesh A, Allen MA, Shen KR, Sharaf B, Moran SL. Intrathoracic Muscle Flap Transposition for the Management of Chronic Pulmonary Aspergillosis. J Plast Reconstr Aesthet Surg 2020; 73:1815-1824. [PMID: 32593571 DOI: 10.1016/j.bjps.2020.05.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/04/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The management of chronic pulmonary aspergillosis remains a challenge for thoracic and reconstructive surgeons. Different management options have been proposed with no consensus regarding the best treatment modality. The goal of this study is to report our experience with the use of intrathoracic muscle flaps for the management of pulmonary aspergillosis. METHODS We retrospectively reviewed all patients who underwent intrathoracic muscle flap transposition for the management of pulmonary aspergillosis between 1990 and 2010. Demographics, surgical characteristics, and treatment outcomes were collected and analyzed. RESULTS A total of 39 patients who underwent 48 muscle flaps were identified. The majority were classified as ASA 3 (n=30, 77%) or ASA 4 (n=8, 21%). Serratus anterior was the most common flap used (n=34), followed by latissimus dorsi (n=6) and pectoralis major (n=5). Flap loss was encountered in three (8%) patients (2 partial, 1 total). Bronchopleural fistula and empyema comprised the two most common intrathoracic complications (26%, 29% respectively). Median follow-up was 33 months (range, 0-216). Successful treatment was achieved in 77% of patients, while operative mortality was 23%. CONCLUSION The use of intrathoracic muscle flaps can be a helpful adjunct to surgical resection in the treatment of chronic pulmonary aspergillosis with low rates of flap loss.
Collapse
Affiliation(s)
- Malke Asaad
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW Rochester, MN
| | | | - Arya A Akhavan
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Tony T C Huang
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW Rochester, MN
| | - Aashish Rajesh
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mark A Allen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - K Robert Shen
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Basel Sharaf
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW Rochester, MN
| | - Steven L Moran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW Rochester, MN.
| |
Collapse
|
7
|
Asaad M, Van Handel A, Akhavan AA, Huang TCT, Rajesh A, Allen MA, Shen KR, Sharaf B, Moran SL. Muscle Flap Transposition for the Management of Intrathoracic Fistulas. Plast Reconstr Surg 2020; 145:829e-838e. [PMID: 32221235 DOI: 10.1097/prs.0000000000006670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intrathoracic fistulas pose unique challenges for thoracic and reconstructive surgeons. To decrease the incidence of fistula recurrence, pedicled flaps have been suggested to buttress the repair site. The authors aimed to report their experience with muscle flap transposition for the management of intrathoracic fistulas. METHODS A retrospective review of all patients who underwent intrathoracic muscle flap transposition for the management of intrathoracic fistulas from 1990 to 2010 was conducted. Patient demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS A total of 198 patients were identified. Bronchopleural fistula was present in 156 of the patients (79 percent), and 48 had esophageal fistula (24 percent). A total of 238 flaps were used, constituting an average of 1.2 flaps per patient. After the initial fistula repair, bronchopleural fistula complicated the course of 34 patients (17 percent), and esophageal fistula occurred in 13 patients (7 percent). Partial flap loss was identified in 11 flaps (6 percent), and total flap loss occurred in four flaps (2 percent). Median follow-up was 27 months. At the last follow-up, 182 of the patients (92 percent) had no evidence of fistula, 175 (89 percent) achieved successful chest closure, and 164 (83 percent) had successful treatment. Preoperative radiation therapy and American Society of Anesthesiologists score of 4 or greater were identified as risk factors for unsuccessful treatment. CONCLUSIONS Intrathoracic fistulas remain a source of major morbidity and mortality. Reinforcement of the fistula closure with vascularized muscle flaps is a viable option for preventing dehiscence of the repair site and can be potentially life-saving. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Malke Asaad
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Amelia Van Handel
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Arya A Akhavan
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Tony C T Huang
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Aashish Rajesh
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Mark A Allen
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - K Robert Shen
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Basel Sharaf
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Steven L Moran
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| |
Collapse
|
8
|
Shao W, Zhang J, Ma S, Feng H, Zhang Z, Liang C, Liu D. Characteristics of pulmonary mucormycosis and the experiences of surgical resection. J Thorac Dis 2020; 12:733-740. [PMID: 32274139 PMCID: PMC7139020 DOI: 10.21037/jtd.2019.12.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Pulmonary mucormycosis (PM) is a relatively rare but fatal infection. However, detailed surgery data have been lacking. We summarized the characteristics of this rare disease and clarified the experiences of surgical resection Methods We conducted a single-center retrospective study of seven patients with PM who underwent surgical resection at China-Japan Friendship Hospital from May 2011 to May 2018. Results Patient ages ranged from 18 to 70 years, with a median age of 47 years. Manual workers (85.7%) were the most common occupation and their educational level was also below high school. Diabetes was the most common underlying condition. The most common radiographic finding was lobar consolidation. Three patients directly underwent open thoracotomy, one patient underwent video-assisted thoracic surgery (VATS) and three patients converted from VATS to thoracotomy. The median operation time was 240 min [interquartile range (IQR), 150–390 min], the median intraoperative blood loss was 500 mL (IQR, 100–1,200 mL) and the median intraoperative blood transfusion was 600 mL (IQR, 0–1,600 mL). In-hospital, 90-day, 1-year and 5-year mortality were 14.3%, 14.3%, 28.8% and 42.9%, respectively. Conclusions PM is a rare but fatal infection. Due to chest adhesion and vascular invasion, the proportion of massive bleeding and long operation time has increased sharply.
Collapse
Affiliation(s)
- Weipeng Shao
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| | - Jun Zhang
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| | - Shanwu Ma
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| | - Hongxiang Feng
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhenrong Zhang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chaoyang Liang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of General Thoracic Surgery, Peking University China-Japan Friendship School of Clinical Medicine and China-Japan Friendship Hospital, Beijing 100029, China
| |
Collapse
|
9
|
Mammana M, Marulli G, Zuin A, Perissinotto E, Comacchio GM, De Franceschi E, Rea F. Postpneumonectomy bronchopleural fistula: analysis of risk factors and the role of bronchial stump coverage. Surg Today 2019; 50:114-122. [PMID: 31493198 DOI: 10.1007/s00595-019-01871-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/11/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Bronchopleural fistula (BPF) is a potentially fatal complication of pneumonectomy. We analyze its occurrence rate, risk factors, and the methods used for its prevention. METHODS We reviewed the medical records of patients who underwent pneumonectomy at our Institution between January, 1990 and March, 2016. The risk factors for postoperative BPF were analyzed by univariate analysis and multiple logistic regression. RESULTS Over the study period, 511 patients underwent pneumonectomy for non-small cell lung cancer (NSCLC) and had the bronchus closed by manual suturing. BPF developed in 23 patients (4.5%). Multiple logistic regression identified no coverage of the bronchial stump, right-sided pneumonectomy, residual tumor in the bronchial stump, postoperative ventilatory support, and completion pneumonectomy, as independent risk factors for BPF. The cumulative rate of BPF decreased significantly over time from 18% between 1990 and 1995 to 1% between 2011 and 2016 (p < 0.001). Concurrently, the data of several patients showed a significant positive trend over time, including bronchial stump coverage (BSC). DISCUSSION Several known risk factors for BPF were confirmed. The more frequent usage of tissue flaps for coverage of the bronchial stump may have contributed to the reduction in the rate of postoperative BPF over time.
Collapse
Affiliation(s)
- Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation, University Hospital of Bari, Piazza Giulio Cesare, 11, 70120, Bari, Italy.
| | - Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Egle Perissinotto
- Biostatistic Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Elisa De Franceschi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| |
Collapse
|
10
|
Mazzella A, Pardolesi A, Maisonneuve P, Petrella F, Galetta D, Gasparri R, Spaggiari L. Bronchopleural Fistula After Pneumonectomy: Risk Factors and Management, Focusing on Open-Window Thoracostomy. Semin Thorac Cardiovasc Surg 2017; 30:104-113. [PMID: 29109057 DOI: 10.1053/j.semtcvs.2017.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/11/2022]
Abstract
We evaluated principal risk factors and different therapeutic approaches for post-pneumonectomy bronchopleural fistula (BPF), focusing on open-window thoracostomy (OWT). We retrospectively reviewed all patients treated by pneumonectomy for lung cancer from 1999 to 2014; we evaluated preoperative, operative, and postoperative data; time between operation; and fistula formation, size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. P values <0.05 were considered significant. BPF occurred in 60 of 733 patients (8.2%). Bronchial suture with Stapler (EndoGia) (P = 0.02), right side (P = 0.003), and low preoperative albumin levels (< 3.5 g/dL) (P = 0.02) were independent predicting factors of fistula. Early BPF was treated by thoracotomic (12) or thoracoscopic (2) debridement of necrotic tissue and BPF surgical repair. Late BPF was treated by bronchoscopic application of fibrin glue (3) or endobronchial stent (1), chest tube and cavity irrigation by povidone-iodine (15). OWT was performed in 27 patients, followed by muscle flap interposition in 7 of these 27. The survival time of patients after the treatment of BPF was 29.0 months. The overall survival of patients treated by OWT was 50% at 2 years and 27 (8%) at 4 years. Correct management of BPF depends on several factors. In case of failure of different initial therapeutic approaches, we could consider OWT, followed by myoplasty.
Collapse
Affiliation(s)
- Antonio Mazzella
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | | | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Francesco Petrella
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology/Oncology-DIPO, University of Milan, Milan, Italy.
| |
Collapse
|
11
|
Mazzella A, Pardolesi A, Maisonneuve P, Petrella F, Galetta D, Gasparri R, Spaggiari L. WITHDRAWN: Bronchopleural fistula after pneumonectomy: Risk factors and management, focusing on open window thoracostomy. J Thorac Cardiovasc Surg 2017:S0022-5223(17)31189-3. [PMID: 28697892 DOI: 10.1016/j.jtcvs.2017.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/17/2017] [Accepted: 05/31/2017] [Indexed: 11/25/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
Collapse
Affiliation(s)
- Antonio Mazzella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | | | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology/Oncology, University of Milan, Milan, Italy
| |
Collapse
|
12
|
Abstract
Empyema after anatomic lung resection is rare but causes serious morbidity, particularly if associated with a bronchopleural fistula. Careful assessment of preoperative risk factors and proper surgical technique can minimize risks. Empyema after segmentectomy or lobectomy may respond to simple drainage and antibiotics, or may require decortication with or without muscle transposition. After pneumonectomy, treatment principles include initial drainage of the intrathoracic space, closure of the fistula if present, and creation of an open thoracostomy, which is packed and later closed. Success rates can exceed 80%.
Collapse
Affiliation(s)
- Giorgio Zanotti
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Academic Office 1, Room 6602, C-310, 12631 East 17th Avenue, Aurora, CO 80045, USA
| | - John D Mitchell
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Academic Office 1, Room 6602, C-310, 12631 East 17th Avenue, Aurora, CO 80045, USA.
| |
Collapse
|
13
|
Camagni S, Lucianetti A, Ravelli P, Di Dedda GB, Bonanomi E, Corno V, Aluffi A, Pinelli D, Zambelli MF, Guizzetti M, Parigi P, Colledan M. The successful management of a Bronchoesophageal fistula after lung transplantation: a case report. Transpl Int 2015; 28:884-7. [PMID: 25789815 DOI: 10.1111/tri.12561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 11/24/2014] [Accepted: 03/09/2015] [Indexed: 11/28/2022]
Abstract
We describe an unprecedented, disastrous complication after bilateral lung transplantation (BLT), a bilateral bronchial dehiscence with a right bronchoesophageal fistula leading to life-threatening septic shock. We also report the successful endoscopic management of this complication by double stenting and stress the efficacy of the multidisciplinary approach to this critical case.
Collapse
Affiliation(s)
- Stefania Camagni
- Department of Surgery, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Paolo Ravelli
- Department of Internal Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Ezio Bonanomi
- Department of Intensive Care, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Vittorio Corno
- Department of Surgery, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Domenico Pinelli
- Department of Surgery, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Marco F Zambelli
- Department of Surgery, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Piercarlo Parigi
- Department of Internal Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Colledan
- Department of Surgery, Hospital Papa Giovanni XXIII, Bergamo, Italy
| |
Collapse
|
14
|
Wilson MA, Seder C, O'Donnell ME, Cassivi SD. Thymic flap for bronchial stump reinforcement after lobectomy. Ann Thorac Surg 2015; 99:1071-3. [PMID: 25742835 DOI: 10.1016/j.athoracsur.2014.05.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 04/18/2014] [Accepted: 05/08/2014] [Indexed: 11/17/2022]
Abstract
Buttressing of the bronchial stump after pulmonary resection has been reported to decrease the prevalence of bronchopleural fistula. This adjuvant maneuver is most commonly performed in patients undergoing resection for infection or in those who have received preoperative radiation. The anatomic location of the upper lobe bronchus often makes it difficult to create a tension-free flap using muscle or pericardial fat. Parietal pleura is often mobilized for such cases. We present a case in which the parietal pleura was not available, and the right inferior pole of the thymus was used for bronchial coverage following upper lobectomy.
Collapse
Affiliation(s)
- Megan A Wilson
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mark E O'Donnell
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, Arizona
| | | |
Collapse
|
15
|
Perentes JY, Abdelnour-Berchtold E, Blatter J, Lovis A, Ris HB, Krueger T, Gonzalez M. Vacuum-assisted closure device for the management of infected postpneumonectomy chest cavities. J Thorac Cardiovasc Surg 2015; 149:745-50. [DOI: 10.1016/j.jtcvs.2014.10.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 09/03/2014] [Accepted: 10/06/2014] [Indexed: 12/11/2022]
|
16
|
Seder CW, Allen MS, Cassivi SD, Deschamps C, Nichols FC, Olivier KR, Shen KR, Wigle DA. Stage IIIA Non-Small Cell Lung Cancer: Morbidity and Mortality of Three Distinct Multimodality Regimens. Ann Thorac Surg 2013; 95:1708-16. [DOI: 10.1016/j.athoracsur.2013.02.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 02/09/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
|
17
|
Benhamed L, Bellier J, Fournier C, Akkad R, Mathieu D, Kipnis E, Porte H. Postoperative Ischemic Bronchitis After Lymph Node Dissection and Primary Lung Cancer Resection. Ann Thorac Surg 2011; 91:355-9. [DOI: 10.1016/j.athoracsur.2010.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 09/06/2010] [Accepted: 09/09/2010] [Indexed: 10/18/2022]
|
18
|
Sawabata N, Nojiri T, Okumura M. Successful muscle prombage for directly nonclosable extremely calcified bronchial stump. Gen Thorac Cardiovasc Surg 2011; 59:48-51. [PMID: 21225402 DOI: 10.1007/s11748-010-0589-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 01/24/2010] [Indexed: 11/28/2022]
Abstract
Severe diffuse chronic calcification can cause an unsuccessful closure of the bronchial stump. An opened stump must be closed with a tissue flap without fixation using the bronchial wall. We performed successful volume double-layered dressing using a technique whereby we divided the latissimus dorsi muscle above and below the left pulmonary artery over the open stump of a severely calcified bronchus.
Collapse
Affiliation(s)
- Noriyoshi Sawabata
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 L5 Yamada-oka, Suita, Osaka 565-0871, Japan.
| | | | | |
Collapse
|