Bronchial Stump Research Articles

Anesthetic considerations in patients with cystic pulmonary adenomatoid malformations.

Congenital pulmonary adenomatoid malformation (CPAM) is a rare entity. The authors searched the US National Library of Medicine Database, EMBASE, Google Scholar, PubMed Central for anesthetic management in CPAM. The search was performed using the terms: congenital cystic adenomatoid malformation, congenital pulmonary adenomatoid malformation, CCAM, CPAM, anesthetic management. The prognosis of CPAM depends on timely diagnosis, presence of hydrops, degree of hypoplasia of remaining lung, and the size of the lesion. Symptomatic patients must be treated surgically and lobectomy is considered the gold standard. Anesthetic management of such cases is challenging as it involves thoracotomy or thoracoscopic lobectomy or cystectomy and can lead to sudden hemodynamic Collapse. Early extubation should be considered to avoid iatrogenic ventilator-induced bronchial stump dehiscence resulting from positive pressure ventilation.

Surgical Management of Bronchial Stump Complication in Cadaveric Lobar Lung Transplantation

Introduction Lobar lung transplantation (LLTx) allows the use of oversized grafts for small recipients. In this technically demanding and not widely adopted procedure, prolonged air leak, kinking of vascular anastomoses and remaining dead space are frequent complications. We describe our experience in treatening the rarely reported bronchial stump insu!cency (BSI) after LLTx. Case Report Between 1993-2016 we performed 120 cases of LLTx in our center. Among these, 3 developed BSI with empyema. A) 48 year old female with Langerhanscell histiocytosis and BSI of the resected left lower lobe; B) 44 year old male with cystic fibrosis and BSI of the resected right lower lobe; C) 62 year old male with idiopathic pulmonary fibrosis and BSI of the resected right lower lobe. Occurrence of fistula was observed 78 days, 29 days and 39 days after LLTx in A, B and C, respectively. The 3 cases underwent accelerated treatment, consisting of radical debridement of the pleural cavity, packing with wet dressings of diluted 10% povidoneiodine, closure of the bronchial fistula, repeated change of dressings every 2 to 3 days until the chest is macroscopically clean and finally reinforcement of the stump with omentoplasty. Four surgical steps were necessary in case A and C, two in case B. Case A and B recovered well within 6 and 3 days of ICU and had 22 and 39 days overall re-hospitalization, respectively. Case C died 10 days after successful fistula revision due colitis with sepsis in aplasia. Summary A prominent bronchus stump after lower lobectomy in LLTx may cause secretion congestion and focal inflammation that results in BSI. Due to anatomical reasons, a bronchus stump may not be avoided in case of LLTx with right lower lobe resection. Insufficiency can be treated successfully utilizing a multiple stage procedure with suture of the bronchus and covering with omentum flap.

Thoracoscopic Bilobectomy after Bilateral Single Sequential Lung Transplantation in a Cystic Fibrosis Patient with Post-Transplant Airway Stenosis

Introduction Airway complications following lung transplantation are associated with significant morbidity and mortality; they can result to significant functional impairment, poor quality of life and frequent hospitalizations. Anastomotic stenosis remains the commonest post-transplant airway complication with an estimated incidence between 1.6-32%. Non-anastomotic bronchial stenosis is rare and is not reported frequently. Case Report We present the case of a 46-year-old female cystic fibrosis patient requiring right lower bilobectomy following bilateral sequential lung transplant in April 2018, which was complicated by stricture of the right main bronchus requiring serial dilatations. Recurrent chest infections related to chronic Achromobacter xylosoxidans lead to complete right middle and lower lobe consolidation and collapse, with a ventilation/perfusion scan demonstrating almost complete absence of lobar ventilation and perfusion. Subsequent fibrotic narrowing of the bronchus intermedius resulted in bi-lobar failure and right lower bilobectomy in June 2020. Stenting of the bronchus intermedius was not considered feasible because the stenosis was in close proximity to the right upper lobar orifice. Thus, lung resection was undertaken utilizing a 2-port video assisted thoracoscopic technique. Intra-operatively the lung was found to be densely adhered to the chest wall and the diaphragm. Division of adhesions and lung mobilisation was challenging and utilization of various surgical techniques to avoid lacerations and prolonged leakage. Careful dissecting of the atrial cuff anastomosis was done to preserve the upper lobe venous supply. The pulmonary artery branches were dissected through their regular anatomical locations by accessing the oblique fissure. The middle and lower lobe bronchi were divided en bloc within their respective fissures to limit disruption of the vasculature of the bronchial stumps and prevent post-operative fistulae. Summary Treatment of stenotic anastomosis after lung transplantation can be challenging. Our case demonstrates that surgical management may be indicated when more conservative techniques have failed. Limits for surgery in lung failure need constant revisit; our experience shows that management in highly specialized centres improves overall outcomes.

Autologous Multilayered Fibroblast Sheets Can Reinforce Bronchial Stump in a Rat Model

Bronchopleural fistula is one of the most serious postoperative complications caused by the incomplete healing of a bronchial stump. Fibroblasts play an important role in wound healing by facilitating connective tissue formation and inducing angiogenesis. We developed a method for production of multilayered fibroblast sheets that secreted some growth factors and promoted wound healing. The present study aimed to assess the treatment effect of multilayered fibroblast sheets on bronchial stump healing. In this rat model, left pneumonectomy was performed, and multilayered fibroblast sheets derived from autologous oral mucosal tissues were transplanted to the bronchial stump. The changes in the bronchial stump were examined macroscopically, histologically, and mechanically. The fibroblast sheets promoted the formation of thick connective tissues around the bronchial stump. The formed connective tissues were accompanied by new blood vessels, and fibrosis was observed over time. Then, 7 days after the transplantation of the fibroblast sheets, the bronchial wall became significantly thicker, and the area of the blood vessels for the bronchial wall tissues was significantly larger in the experimental group than in the control group. In addition, the burst pressure in the bronchial stump was significantly higher in the experimental group than in the control group. Bronchial stumps were reinforced by the transplantation of multilayered fibroblast sheets derived from autologous oral mucosal tissues.

Negative-pressure wound therapy in combination with bronchial occlusion to treat bronchopleural fistula: a case report

BackgroundBronchopleural fistula, which usually accompanies bronchial fistula and empyema, is a severe complication of lung cancer surgery. Negative-pressure wound therapy can enhance drainage and reduce the empyema cavity, potentially leading to early recovery. This therapy is not currently indicated for bronchopleural fistulas because of the risk of insufficient respiration due to air loss from the fistula.Case presentationA 73-year-old man, who was malnourished because of peritoneal dialysis, was referred to our hospital for the treatment of lung cancer. Right lower lobectomy with mediastinal lymph node dissection was performed via posterolateral thoracotomy, and the bronchial stump was covered with the intercostal muscle flap. His postoperative course was uneventful and he was discharged. However, he was readmitted to our hospital because of respiratory failure and diagnosed as having bronchopleural fistula on the basis of the bronchoscopic finding of a 10-mm hole at the membranous portion of the inlet of the remnant lower lobe bronchus. Thus, thoracotomy debridement and open window thoracostomy were immediately performed. After achieving infection control, bronchial occlusion was performed using fibrin glue and a polyglycolic acid sheet was inserted through a fenestrated wound. Bronchial fistula closure was observed on bronchoscopy; therefore, a negative-pressure wound therapy system was applied to close the fenestrated wound. The collapsed lung was re-expanded and the granulation tissue around the wound increased; therefore, thoracic cavity size decreased and thoracoplasty using the latissimus dorsi was performed.ConclusionsThis bronchopleural fistula was treated successfully after a right lower lobectomy using an extra-pleural bronchial occlusion and negative-pressure wound therapy.

Prophylactic Bronchial Stump Support With Intrathoracic Muscle Flap Transposition.

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. 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. 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%). 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.

Bronchial mucosal ablation for bronchial stump closure in right pneumonectomy: a case report

BackgroundBronchial fistula is a severe complication of pneumonectomy with a high mortality rate. We previously reported a technique for bronchial closure to prevent bronchial fistula in a canine model. We described that mucosal ablation could result in primary wound healing and involve mucosal tight adhesions histologically. In this paper, the pathologic findings of one patient, who underwent autopsy 4 years after surgery, were reviewed.Case presentationA 70-year-old Japanese man was diagnosed with malignant pleural mesothelioma and underwent right extra-pleural pneumonectomy. The right main bronchus was cut using a scalpel. When closing the bronchial stump, the bronchial mucosa was ablated by electric cautery and sutured manually using 3-0 absorbable sutures. The bronchial fistula was not found after pneumonectomy. Four years after surgery, the patient died of recurrent malignant pleural mesothelioma and underwent autopsy. Macroscopic evaluation showed tight adhesions and white scars on the bronchial stump. Microscopic findings showed few inflammatory cells and α-smooth muscle actin (α-SMA)-positive cells.ConclusionsThe results from this case suggested that bronchial mucosal ablation leads to robust agglutination of bronchial stump over years. This technique is not only simple but also reliable to prevent bronchial fistula.

Clinical Outcomes and Prognostic Factors of Salvage Stereotactic Body Radiotherapy for Post-Surgical Thoracic Oligo-Recurrence/Metastasis of Non-Small-Cell Lung Cancer.

PurposeThe study aimed to assess the efficacy and safety of stereotactic body radiotherapy (SBRT) using CyberKnife (CK) in patients with postoperative thoracic oligo-recurrence/metastasis of non-small-cell lung cancer (NLCLC), and to analyze the prognostic factors affecting overall survival after SBRT.Patients and MethodsA total of 44 patients with postoperative thoracic oligo-recurrence/metastatic of NLCLC treated with SBRT were reviewed. Thoracic oligo-recurrence/was defined as 1–3 loco-regional confined to lung lobe, hilar/mediastinal lymph nodes, bronchial stump, or chest wall. Primary endpoints included local control (LC), overall survival (OS), progression-free survival (PFS) and toxicity. Prognostic factors that affected these patients were analyzed by the univariate and multivariate analysis by Kaplan–Meier methods and Cox regression models, respectively.ResultsThe median follow-up time after salvage SBRT was 48.5 months. Measuring from the date of salvage SBRT, the median OS of the 44 patients was 52.60 (95% CI: 29.59–75.60) months. 1-,3-and 5-year OS rates were 97.7%, 65.3% and 47.7%, respectively. The 1-,3-year and 5-year LC rates were 97.7%, 85.1% and 80.1%, respectively. At 1, 3 and 5 years, the PFS rates were 77.1%, 28.8% and 5.3%, respectively. Multivariate analysis demonstrated that pre-SBRT neutrophil-to-lymphocyte ratio (NLR) and Charlson comorbidity index (CCI) were independent prognostic factors (p < 0.05). The treatment-related side-effects were well tolerated. No patients developed grade 3 or greater pulmonary toxicity.ConclusionSBRT is a promising salvage therapeutic option for postoperative thoracic oligo-recurrence/metastasis of non-small-cell lung cancer with acceptable toxicity. Low pre-SBRT neutrophil-to-lymphocyte ratio (NLR) and low Charlson comorbidity index (CCI) were associated with a better prognosis and longer survival and might be considered as reliable and independent prognostic factors in these patients treated with SBRT.

A novel approach for ventilation with Aintree catheter during rigid bronchoscopy: A non-ventilated case report.

Herein, we present a novel method to overcome difficult ventilation in a patient with a carinal tumor. After induction of anesthesia, we observed difficult ventilation due to obstruction of the right main bronchus as a result of herniation of the tumor mass arising from the left bronchial stump. Traditional lung ventilation techniques were not an option under these conditions. Therefore, the Aintree intubation catheter was used to obtain a patent airway and, with this technique, the patient was successfully and securely ventilated throughout the whole procedure. To the best of our knowledge, this technique is the first to describe successful ventilation during rigid bronchoscopy in a case with a tracheal carinal tumor.

ЗАСТОСУВАННЯ КЛАПАННОЇ БРОНХОБЛОКАЦІЇ У ЛІКУВАННІ ХІМІОРЕЗИСТЕНТНОГО ТУБЕРКУЛЬОЗУ ЛЕГЕНЬ

O. I. Shpak, V. B. Bychkovskyi, O. B. Randiuk, M. S. Opanasenko, O. V. Tereshkovich, B. N. Konik, O. A. Gaidar, L. I. Levanda Аbstract Endoscopic bronchial valve blocking is a type of interventional bronchoscopy, which makes a therapeutic hypoventilation with the subsequent development of atelectasis in the affected area of the lung while maintaining the drainage function of the blocked bronchus and the cavity of destruction or closure of the bronchial defect by using an endobronchial valve. Aim: to evaluate the results valvular bronchial blocking in patients with chemo-resistant pulmonary tuberculosis (CRPTB) instead of surgical intervention or in the postoperative period. Materials and methods. 94 bronchial blockages were performed in patients with CRPTB. The patients were divided into three groups. Group I (36 patients) — a valve was placed during chemotherapy without surgical treatment. Group II (31 patients) — pyopneumothorax with destruction cavity discharge into the pleural cavity. Group III (27 patients) — volume reduction surgery(lobectomy, bilobectomy and pulmonectomy), complicated by the bronchial stump incompetency. Results. In group I favorable outcomes were observed in 27 cases (75,0 %). In patients with pneumothorax, complicated by empyema of the pleural cavity and bronchopulmonary fistula (group II) the favorable outcomes were achieved in 28 (90,3 %) patients. In postoperative patients, undergoing different volume reduction interventions (group III), favorable otcomes were registered in 23 (85,2 %) patients. Conclusion. Valvular bronchial blocking is highly effective method in the treatment of patients with CRPTB and certain complications (empyema of the pleural cavity with bronchopulmonary fistula, failure of the bronchial stump in the postoperative period), and in patients, who already underwent surgery, as well. Key words: chemo-resistant pulmonary tuberculosis, complications, bronchial valve blocking, surgical treatment.

Complications of thoracic surgery: post-pneumonectomy bronchopleural fistula

: 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. Meta-analysis 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.

Anesthetic considerations in an infant with congenital cystic adenomatoid malformation

Congenital cystic adenomatoid malformation (CCAM) is a rare developmental disorder of lower respiratory tract in which child presents with severe respiratory distress, pneumonitis or sepsis. Anesthetic management of such children is challenging owing to hyperinflation or rupture of cystic lesions or iatrogenic pneumothorax with positive pressure ventilation, sudden hemodynamic collapse during induction, excessive bleeding and situation becomes more challenging if child is presenting with sepsis. We report successful management of 42 days old infant with CCAM with pneumonitis and sepsis who underwent lobectomy and was successfully extubated on operating table with meticulous planning and optimum perioperative management. Early extubation is desirable to avoid iatrogenic ventilator induced bronchial stump dehiscence by positive pressure ventilation. Keywords: Anesthesia considerations, Congenital cystic adenomatoid malformation, Pneumonitis, Sepsis.

Postoperative complications and perioperative management in patients on hemodialysis undergoing lung resection.

The rate of lung resection in patients on hemodialysis (HD) is increasing with the increasing number of HD. However, studies assessing lung resection in HD are limited. The study aimed to investigate the perioperative management and postoperative complications of lung resection in HD patients. Between 2007 and 2019, of the 4989 patients underwent lung resection, 43 patients had been receiving HD. We compared the characteristics of a Clavien-Dindo classification grade ≥ 2 group against grade ≤ 1 group. Predictive factors of complications were analyzed by logistic regression analysis. Thirty-three patients were men (median age: 69years). Thirty-eight patients had lung cancer. The reason for HD was diabetic nephropathy in 19 patients, nephrosclerosis in 10, and miscellaneous in 14. The median duration of HD before surgery was 64.6months. The type of lung resection was lobectomy in 24, segmentectomy in 10, and partial resection in 9 patients. Bronchial calcification was detected in 16 (37%). Reinforcement at the stump was performed in 9 lobectomies, of which 6 involved bronchial calcification. Postoperative complications were detected in 21 (49%), including grade ≥ 2 complications in 14 (33%). Multivariate analysis revealed that pack-year smoking ≥ 10 (p = 0.01) and operation time ≥ 140min (p = 0.02) were predictors of grade ≥ 2 morbidity. Heavy smoking and longer operative time may result in postoperative complication requiring therapeutic intervention. The frequency of bronchial calcification is relatively high in HD patients, and reinforcement of the calcified bronchial stump should be considered during lobectomy.

Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula?

Background/aimThe development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence.MethodsThis is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years.ResultsOut of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified.ConclusionThe idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.

Bronchoscopic treatment of a bronchopleural fistula after pneumonectomy.

Bronchoscopic treatment of a bronchopleural fistula after pneumonectomy.

Isсhemic change in bronchus stump after lung cancer resection

The OBJECTIVE of the study was to assess the changes in blood supply of the bronchus stump following lung resection with lymph node dissection.METHODS AND MATERIALS. Bronchial microcirculation was studied in 8 patients during pneumonectomy of the wall of the main bronchus using laser Doppler flowmetry method. In this paper, we present our observations of postoperative necrotic ischemic bronchitis after lobectomy with associated formation of bronchopleural fistula of the main bronchus and the failure of the stump of the lobular bronchus.RESULTS. Mobilization of the bronchus decreased microcirculation rate to (3.3±0.3) conventional units (c. u.), or to 74.5 %; lymphatic dissection further reduced microcirculation rate to (2.6±0.2) c. u., or to 60.2 %. An additional twisted suture was found to worsen ischemia. The normalized value of the amplitude decreased during the second minute of the dissection of the bronchus, indicating hypoxia. A 61-year-old patient with diabetes showed damage to the wall of the main bronchus 0.6 cm in size 7 days after undergoing the right lower lobectomy with lymphatic dissection. On the 19th day after the same procedure, the same patient developed an insolvency of the stump of the lower lobe bronchus, which was classified as a manifestation of ischemia. Postoperative ischemic bronchitis can occur in a true ischemic or an ulcerative necrotic form, and it can be diagnosed using a macroscopic picture in the context of fibrobronchoscopy. It occurs in (2.5–3.2) % of patients who underwent lung resections for cancer with lymphatic dissection.CONCLUSION. Ischemia of the bronchial wall during its mobilization plays a significant role in the etiology of bronchopleural fistula. Lymphatic dissection worsens microcirculation of the bronchial wall. Ischemic necrotic bronchitis can lead to formation of the bronchopleural fistula outside of the stump. High-risk patients require additional coverage of the bronchus stump with muscle or fat tissue.

Neoadjuvant chemotherapy combined with intraoperative radiotherapy is effective to prevent recurrence in high-risk non-small cell lung cancer (NSCLC) patients.

BackgroundBasal cell hyperplasia (BCH) and squamous metaplasia (SM) in the small bronchi distant from the tumor is associated with a high risk of non-small cell lung cancer (NSCLC) recurrence. Here, we assessed whether neoadjuvant chemotherapy (NAC), intraoperative radiotherapy (IORT), or adjuvant chemotherapy (AC) is effective to prevent recurrence in NSCLC patients (n=171) with different premalignant lesions in the small bronchiMethodsBCH, SM, and dysplasia (D) were identified in the samples of lung tissue distant from the tumor. NSCLC patients were treated by surgery, different combinations of NAC and IORT, and AC.ResultsBased on the type of bronchial lesions, NSCLC patients were classified into four groups: BCH+SM−D− (55.6%, 95/171), BCH+SM+D− (26.3%; 45/171), BCH−SM+D+ (6.4%, 11/171), and BCH−SM−D− (11.7%, 20/171). During 5 years, recurrent carcinoma was found in 13.4% (23/171) of patients and represented by metachronous metastases in the thoracic lymph nodes (82.6%, 19/23) and by a relapse in the bronchial stump (17.4%, 4/23). Recurrence was frequent in BCH+SM+D− patients (87.0%, 20/23), rare in BCH+SM−D− and BCH−SM−D− patients (13.0%, 3/23), and absent in BCH−SM+D+ patients (0/23). The 5-year recurrence-free survival was also shorter in BCH+SM+D− patients (HR 27.35; 95% CI: 6.31−118.48; P<0.0001). In the high-risk (BCH+SM+D−) group, recurrence occurred mainly in cases without NAC and IORT (88.2%, 15/17) and was absent (0/15) when these therapies were combined. NAC- and IORT-negative patients also showed poor overall survival (HR 4.35; 95% CI: 1.96−9.66; P<0.0001) and tended to have decreased recurrence-free survival (P=0.075). Importantly, the recurrence rate was not different between AC-treated and AC-naïve BCH+SM+D− patients.ConclusionsThe combination of NAC and IORT is an effective strategy to prevent recurrence in high-risk NSCLC patients.

Unusual local and distant metastases after complete resection of roentgenographically occult squamous cell carcinoma.

Roentgenographically occult squamous cell carcinoma (ROSCC) was reported to have been cured after complete resection. We experienced unusual local and distant metastases after complete resection of a ROSCC of left B6 bronchus. During the operation due to the proximal bronchial stump being positive for squamous cell carcinoma (SCC), a left lower sleeve lobectomy was performed. Six years after the operation, a chest CT showed no abnormal shadows. 6months later a PET-CT showed metastases on bilateral supraclavicular lymph nodes, mediastinal lymph nodes, and the right adrenal glands. A biopsy of the right supraclavicular lymph node revealed that it was a metastatic SCC. The possibility of recurrence from a second pulmonary SCC might still remain. A prolonged follow-up over many years is desirable for a heavy smoker with a ROSCC.

Postoperative bleeding from intercostal artery injured by bronchial stump after thoracoscopic lobectomy: A case report

Postoperative bleeding from intercostal artery injured by bronchial stump after thoracoscopic lobectomy: A case report

Evaluation of the Possible Risk Factors on Bronchial Closure Techniques for Bronchopleural Fistula after Lung Resection.

Broncho-pleural fistula (BPF) can occur after pulmonary resections as a complication with high morbidity and mortality rates. In the present study, we analyzed the relation between the possible risk factors and the two major bronchial closure techniques for BPF after lung resections, and the management methods of BPF. A total of 26 cases detected and managed with BPF diagnosis in our clinic between September 2005 and September 2017 were evaluated retrospectively. The cases were divided into two groups: Group 1 (n=14); bronchial closure performed manually and Group 2 (n=12) bronchial closure with stapler. We analyzed cases for age, gender, body mass index, pulmonary function tests, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, presence of bronchial stump coverage, and the mean survivals. Twenty-three of the cases were males (88.5%) with a mean age of 60.03±8.7 years (range 38-73). While BPF was detected in twenty-three (88.5%) of the cases after pneumonectomy, three (11.5%) of them were after lobectomy. There was no statistically significant correlation between the two groups in gender, age, BMI, preoperative FEV1, time to fistula, total protein/albumin level, length of hospital stay, bronchial stump distance, and presence of bronchial stump coverage (chi-square test, p>0.05). As a result of the applied Kaplan-Meier analysis, we found no statistically significant difference in the mean survival rates between the two groups (p>0.05). Broncho-pleural fistulas still remains a major challenge. Although there is no statistical relationship between bronchial closure techniques and possible risk factors in our study, patients should be assessed in terms of possible risk factors. The management strategy for BPF varies according to individual patients’ clinical condition, the size of the fistula, and development time.