Risk Factors For Bronchopleural Fistula Research Articles

Prophylactic effect of tissue flap in the prevention of bronchopleural fistula after surgery for lung cancer.

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. 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. 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 6months postoperatively. 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.

Risk factors for bronchopleural fistula based on surgical procedure and sex in 4794 consecutive patients undergoing anatomical pulmonary resection.

Bronchopleural fistula (BPF) is a lethal complication, even in the modern era. Therefore, we investigated the details of patients with BPF to select an appropriate surgical strategy. This retrospective study included 4794 consecutive patients who underwent anatomical pulmonary resection between 2008 and 2022. We evaluated the predictors of BPF using a multivariable analysis and investigated the mortality and clinical course after BPF in detail. BPF was observed in 32 patients (0.67%). In the multivariable analysis, the predictors for BPF were male sex (odds ratio [OR], 6.91), the body mass index (OR, 2.40), the vital capacity (%VC) (OR, 2.93), surgery performed (right lower lobectomy [OR, 10.92], right middle and lower lobectomy [OR, 6.97], and right pneumonectomy [OR, 16.68]), and additional resection of surrounding organs (OR, 3.47). Among the risk factors, surgery performed and male sex were very strong risk factors, with the frequency itself very low in females (0.1%). The 90-day mortality was 15.6%, and the 5-year overall survival in patients with BPF was 28.1%. Our study revealed that independent risk factors and consideration of the surgical methods and sex might help determine whether or not special attention should be given to the bronchial stump, which will be of great help in surgical strategies.

Risk factors for bronchopleural fistula after lobectomy for lung cancer.

Bronchopleural fistula (BPF) after lobectomy for lung cancer is a rare but serious complication. This study aimed to stratify the risk factors of BPF. Patients who underwent lobectomy without bronchoplasty and preoperative treatment for lung cancer between 2005 and 2020 were retrospectively reviewed. We examined the association between the incidence of BPF and background factors, including comorbidities, preoperative blood test results, respiratory function, surgical procedure, and extent of lymphadenectomy. Among the 3,180 patients who underwent lobectomy, 14 (0.44%) developed BPF. The median interval from surgery to BPF onset was 21 days (range, 10-287). Two of the 14 patients died of BPF (mortality rate, 14%). All 14 patients who developed BPF were men and had undergone right lower lobectomy. Other factors significantly associated with the development of BPF were older age, heavy smoking, obstructive ventilatory failure, interstitial pneumonia, history of malignancy, history of gastric cancer surgery, low serum albumin levels, and histology. Multivariable analysis in the subgroup of men who underwent right lower lobectomy revealed that high level of serum C-reactive protein and a history of gastric cancer surgery were significantly associated with BPF, whereas bronchial stump coverage was inversely associated with BPF. Men who underwent right lower lobectomy were at increased risk of BPF. The risk was higher when the patient had high serum C-reactive protein or a history of gastric cancer surgery. Bronchial stump coverage might be effective in patients at high risk of BPF.

Risk factors and outcomes of bronchopleural fistula after bronchoplasty in patients with non-small cell lung cancer: a retrospective multivariate analysis.

BackgroundBronchopleural fistula (BPF) is a rare but severe complication following bronchoplasty. Identification of the risk factors for the development of BPF after bronchoplasty may contribute to better perioperative management, thereby further improving the prognosis of these patients. However, few studies have focused on the risk factors for BPF after bronchoplasty. This study aimed to explore the risk factors and outcomes for BPF after bronchoplasty in patients with non-small cell lung cancer (NSCLC).MethodsThe data of NSCLC patients who underwent bronchoplasty between September 2005 and August 2020 in our institution were retrospectively reviewed. Detailed information on demographic characteristics, preoperative assessment, perioperative outcomes were collected from Western China Lung Cancer Database. The diagnosis of BPF was confirmed by bronchoscopy. Risk factors for BPF were assessed by univariate and multivariate logistic regression analysis.ResultsA total of 503 patients were included in this study, including 132 (26.2%) cases of broncho-vascular plasty, 340 (67.6%) cases of bronchial sleeve lobectomy, and 31 (6.2%) cases of bronchial wedge plasty. Among these patients, 16 (3.2%) developed postoperative BPF. Six patients with BPF died during hospital-stay, including two cases of severe hemoptysis, and four cases of pyothorax and respiratory failure caused by BPF. One of the other ten patients underwent reoperation. After univariate and multivariate logistic regression analysis, preoperative Charlson Comorbidity Index (CCI) ≥2 [odds ratio (OR) =5.120, 95% confidence interval (CI): 1.193–21.985, P=0.028], right middle and/or lower lobectomy (OR =4.840, 95% CI: 1.133–20.686, P=0.033), and residual tumor in the bronchial margin (OR =4.160, 95% CI: 1.106–15.644, P=0.035) were identified as independent risk factors for postoperative BPF.ConclusionsAlthough complication rate of BPF after bronchoplasty is low, the mortality of BPF is high. Patients with higher CCI, those who undergo right middle and/or lower lobectomy, and those with residual tumor in the bronchial margin are at increased risk of BPF. This study highlights the importance of preoperative evaluation and good intraoperative management to prevent this catastrophic complication.

Analysis of Risk Factors for Bronchopleural Fistula after Surgical Treatment of Lung Cancer.

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.

Frequency and Risk Factors of Bronchopleural Fistula in Tube Thoracostomy Patients

Frequency and Risk Factors of Bronchopleural Fistula in Tube Thoracostomy Patients

Risk factor of bronchopleural fistula after general thoracic surgery: review article

The aim of this article was to clarify recent risk factors for the early bronchopleural fistula after anatomical lung resection. Reports on early bronchopleural fistula after anatomical lung resection in adults, including information on risk factors, published between 2006 and 2016 were reviewed and our institutional data were evaluated. The early period was defined as within 30days from surgery or as described early in the manuscript. A total of seven retrospective observational articles were selected. Four articles investigated lobectomy and pneumonectomy, while the other three articles investigated only pneumonectomy. The surgical procedure, preoperative therapy, complications after surgery, right side, patient age, past history, and tumor residuals were mentioned as risk factors of bronchopleural fistula. Our data concluded that neoadjuvant therapy and a right lower lobe location were risk factors after a lobectomy, while a right side and complete pneumonectomy were risk factors after a pneumonectomy. Although recent studies have reached nearly the same conclusions as older reports, continuous research of potential risk factor is needed as therapeutic procedures continue to evolve.

P1.31: Pleural Empyema and Broncho Pleural Fistula After Lung Resection: Analyses of 29 Patients Treated in our Clinic

Broncho pleural fistula (BPF) and pleural empyema are seriously complications after anatomical and non anatomical lung resection although is rare. But with high mortality rate particularly after radical pneumonectomy. a BPF may arise either from dehiscience or disruption of a bronchial closure after anatomical lung resection (segmentectomy, lobectomy; bilobectomy, pneumonectomy)or bronchoplastic sleeve resection and nonanatomical lung resection (wedge resection).Postoperative bronchopleural fistula is classified based in time of onset after surgery; as early (within first week); Intermediate (between 7 and 30 days);and late after (30 days). Malnutrition, imunosuppressive steroids therapies, prior thoracic radiation therapy, poorly controlled lung and pleural infection, active smokers, and the use of induction of chemotherapy are a number of predisposing factors that may developing bronchial fistula and subsecuent pleural empyema. Also others factors related with technical side are, long bronchial stump, large diameter bronchial stump, positive resection margin of bronchial stump, devascularisation of bronchial stump from cauter or unappropriate sutures during bronchial closure. Also risk factors for bronchopleural fistula are right Pneumonectomy, Diabetes, Completion Pneumonectomy, Active TB, Extrapleural Pneumonectomy, COPD, positive pressure ventilation, large postoperative fluid requirement, benign diagnosis prolonged chest tube utiliz. Empyema and BPF are extremely uncommon after lobetomy in contemporary series, particularly after thoracoscopic lobectomy. Empyema is seen in less than 2% of cases, and BPF in less than 1%. Post-pneumonectomy BPF and empyema are associated with mortality rates that vary from 5% up to nearly 50%. We are analysing our patients treated with pleural empyema and bronchopleural fistula, treated previously with lung resection,anatomical und non anatomical for malignant und benignen lung disease.Its retrospective study for period of time 2005-2015.The number of patients treated during 2005-2016 with pulmonary rezexion is 560.Mean age of patients 58±5.6 years (ranging from 13-87 years old).Male 420 patients and female 140 patients. Realized of kind Interventi are 47 patients pneumonectomy, 448 patiens anatomical lobectomy, 12 patients segmentectomy, 18 patients bilobectomy, 35 patients non anatomical resection (wedge lung resection). Bronchial fistula as a major complication occurred in 29 patients after lobectomy in 16 patients, after pneumonectomy in 8 patients, in 5 patients after right pneumonectotmise and 3 after left pneumonectomy, in 3 patients after segmentectomy, in 2 patients after wedge lung resection. Fistul bronchial pulmonary without pleural empyema 3 patients. Treated only pleural dranage for a long time 11 patients. In 2 patients are treated by using of fibrin glue bronchoscopicaly in bronchial fistulae under 5 mm and without infection. By open window are treated 18 patients according Elosser and Clagett –Virculla. Mean time hospital stay of patients treated with bronchial fistula et pleural empyema is 25 ± 5 days (average 5-90 days). 90 days mortality was in 5 patients in 2 patents post after lower bilobectomy and in 2 patients after right and left pneumonectomy, 1 patient after wedge lung resection. Cause of deaths, respiratory failure, sepsis, toxic shock. The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians and surgeons. It is associated with significant morbidity and mortality.

Neoadjuvant therapy and risk of bronchopleural fistula after lung cancer surgery: a systematic meta-analysis of 14 912 patients.

Neoadjuvant therapy has been extensively analyzed in studies addressing the risk factors of bronchopleural fistula, but their results vary hugely. Therefore, we conducted this meta-analysis to determine the association between neoadjuvant therapy and risk of bronchopleural fistula in patients undergoing lung cancer surgery. We searched PubMed and EMBASE to identify the full-text literatures that met our eligibility criteria. Odds ratio with 95% confidence interval served as the summarized statistics. Heterogeneity within this meta-analysis was evaluated by Q-test and I (2) statistic. Sensitivity analysis was performed for further assessments of robustness. Publication bias was detected by Begg's test and Egger's test. Thirty studies enrolling 14 912 lung cancer cases were included into this meta-analysis. The incidence of bronchopleural fistula was 2.4% (354/14 912) in the large scale. Overall, neoadjuvant therapy significantly increased the risk of bronchopleural fistula after pulmonary resections (odds ratio: 2.166; 95% confidence interval: 1.398-3.357; P = 0.001). In subgroup analysis, neoadjuvant radiotherapy (odds ratio: 3.914; 95% confidence interval: 1.401-10.935; P = 0.009) and chemo-radiation (odds ratio: 2.533; 95% confidence interval: 1.353-4.741; P = 0.004) were significantly associated with the bronchopleural fistula risk but neoadjuvant chemotherapy was not (odds ratio: 1.857; 95% confidence interval: 0.881-3.911; P = 0.104). The impact of neoadjuvant therapy on bronchopleural fistula occurrence remains statistically prominent in the other subgroups. Neoadjuvant therapy is significantly associated with the occurrence of bronchopleural fistula after lung cancer surgery. Both neoadjuvant radiotherapy and chemo-radiation significantly increase the bronchopleural fistula risk but neoadjuvant chemotherapy does not. Some limitations still exist in this meta-analysis. The updated high-quality studies can help to further confirm and enrich our discoveries in the future.

Neoadjuvant chemotherapy is a risk factor for bronchopleural fistula after pneumonectomy for non-small cell lung cancer.

IntroductionPerforming pneumonectomy after neoadjuvant chemotherapy is still controversial. Bronchopleural fistula is a major complication after pneumonectomy. In this study the effect of neoadjuvant chemotherapy on postpneumonectomy bronchopleural fistula was investigated.Material and methodsA retrospective review of patients who underwent pneumonectomy for non-small cell lung cancer from January 2005 to December 2011 was undertaken. The major complications and operative mortality were analyzed and compared between the patients having neoadjuvant chemotherapy and patients having surgery only.ResultsOne hundred and seventy-seven pneumonectomies (77 right and 100 left) were performed during the study period and 49 of these patients (27.7%) received neoadjuvant chemotherapy. Median age was 60 years (range, 32 to 80). The bronchopleural fistula rate was 26.5% (13/49) in the neoadjuvant group versus 3.1% (4/128) in the surgery alone group (p = 0.029). The bronchopleural fistula rate was 16.9% (13/77) in the right pneumonectomy group vs. 4% (4/100) in the left pneumonectomy group (p = 0.004). Overall operative mortality was 5.6%. Mortality in the neoadjuvant group was 8.2% vs. 4.7% in the surgery only group (p = 0.37).ConclusionsNeoadjuvant chemotherapy and right pneumonectomy is a major risk factor for bronchopleural fistula. Especially right pneumonectomy should be avoided after induction therapy.

Risk Factors for Early Postoperative Complications After Pneumonectomy for Benign Lung Disease

Pneumonectomy is associated with a significant incidence of postoperative complications. The purpose of this study is to identify the risk factors associated with adverse outcomes. One hundred thirty-six patients with benign lung disease who underwent pneumonectomy were included in this retrospective analysis. Postoperative complications were observed during the 30-day follow-up. Univariate and multivariate analysis was performed to investigate the risk factors of pneumonectomy among the patients. Postoperative complications were observed in 33 patients (24.26%). The rate of bronchopleural fistula was 6.1% (9 of 136). Five perioperative deaths (3.68%) were noted. Univariate analysis and multivariate analysis indicated that type of disease (hazard ratio [HR], 3.158; 95% confidence interval [CI], 1.248 to 7.992; p = 0.015) and operation duration (HR, 2.508; 95% CI, 1.035 to 6.080; p = 0.042) were independent risk factors of postoperative complications, and that type of disease (HR, 6.409; 95% CI, 1.669 to 6.021; p = 0.011) and pulmonary function (HR, 6.159; 95% CI, 0.018 to 0.625; p = 0.013) were independent risk factors of bronchopleural fistula for patients with benign lung disease after pneumonectomy. A high incidence of complications was reported among patients with benign lung disease after pneumonectomy. The type of disease and operation duration were the best independent predictors of morbidity after this surgery. With careful patient selection and operative technique, morbidity and mortality rates could be comparable to those for pneumonectomy in cancer patients. Pneumonectomy is still a satisfactory treatment method for benign lung disease.

Reply to Terzi et al.

I thank Terzi et al. [1] for their comments on our article [2] and also thank EJCTS for giving me this opportunity to answer this question. Bronchopleural fistula (BPF) is a most serious complication in patients with tuberculosis-destroyed lungs who have undergone pneumonectomy. Halezeroglu et al. [3] consider that tuberculosis and preoperative empyema lead to BPF. We believe that the risk factors for BPF are the surgical suture technique, endobronchial tuberculosis, multidrug-resistant tuberculosis and pleural space infection, although postoperative BPF after pneumonectomy for tuberculosis-destroyed lungs has been decreasing steadily. The prevention of postoperative BPF in patients with tuberculosisdestroyed lungs is very important in chest surgery. The surgical process for a bronchial stump includes suturing and protection. The suturing includes full-thickness suture, stapler suture and so on. Pleural tissue, pericardial tissue and muscle flaps are used to protect the bronchial stump. But when a tuberculosis-destroyed lung is combined with endobronchial lesions, the suture line of the full-thickness suture and the stapler of the stapler suture for endobronchial tuberculosis may cause a ‘drainage effect’, which could lead to an infection in the chest. So, we think that the ‘drainage effect’ may lead to a BPF. Endobronchial tuberculosis has been demonstrated in up to 18% of tuberculosis patients. Vester et al. [4] think that the stapler is contraindicated when the bronchus is thickened, inflamed or of insufficient length. Thus, we think that the way in which we suture is more important than how the bronchial stump is protected. We suggest that the muscle flap that Terzi et al. [5] use to protect a bronchial stump could be used in the repair surgery after BPF. The extramucous suture technique for bronchia is a method that does not cross the bronchia mucous. In 1963, Xin et al. [6] reported 509 cases (including 487 of pulmonary tuberculosis and 22 of pulmonary suppuration) who underwent pulmonary resection. For the extramucous suture in a bronchia group of 200 patients, the incidence of BPF was 0%. For the full-thickness suture in a bronchia group of 200 patients, the incidence of BPF was 3.0% (six cases). For the stapler suture in a bronchia group of 109 patients, the incidence of BPF was 4.5% (five cases). The way we choose to suture is according to the situation of the mucous membrane. In our hospital, the extramucous suture technique has been routine for patients with endobronchial tuberculosis for half a century, and the incidence of BPF is very low. But reinforcing the bronchial stump with the surrounding tissues can decrease the incidence of postoperative BPF in tuberculosis-destroyed lungs. In addition, standard preand postoperative antituberculosis treatments and a careful operation often lead to satisfactory surgical effects. When patients suffer from multidrug-resistant pulmonary tuberculosis and endobronchial tuberculosis, selective operation indication, adequate preoperative antituberculosis treatment and endobronchial ultrasonic atomization are needed.

The risk factors and treatment of bronchopleural fistula after pneumonectomy

To analyze the risk factors which influencing the development of bronchopleural fistula (BPF) in pulmonary resections for lung cancer. To clarify the preventive techniques and treatment strategies of BPF. Review the clinical data of 32 patients of postpneumonectomy BPF from 965 patients accepted pneumonectomy for lung cancer from May 1987 to May 2007. Univariate and multivariate analyses were performed by the logistic regression procedure to identify the significant risk factors for BPF in 965 pulmonary resections for lung cancer. The prevalence of BPF was 3.3% (32/965). BPF occurred in the right main bronchial stump in 28 patients, left main bronchial stump in 4 patients. The significant risk factors for BPF formation were right pneumonectomy, preoperative irradiation, prolonged mechanical ventilation, bronchial stump more than 2 cm and hypoalbuminemia. Multivariate analysis identified right pneumonectomy, preoperative radiotherapy and hypoalbuminemia as the risk factors of BPF. Successful closure of BPF was achieved in 13 patients (40.6%). The fistula was successfully closed in 5 of 6 patients who had received biologic glues applied bronchoscopically with a fistula less than 3 mm. Pedicled omentum was successfully used for the treatment in 5 of 6 patients with a fistula more than 3 mm. Right pneumonectomy, high-dose preoperative radiation therapy and hypoalbuminemia are risk factors for postpneumonectomy BPF. Biologic glues can be applied bronchoscopically to achieve endobronchial closure of the fistula less than 3 mm. Omentoplasty is useful for the fistula more than 3 mm.

Bronchopleural Fistula after Lobectomy for Lung Cancer

Bronchopleural fistula after lung resection is a fatal complication. The aim of this study was to determine the risk factors for bronchopleural fistula after lobectomy for lung cancer. Clinical records of 767 patients who underwent lobectomy or bilobectomy for lung cancer in our institution were reviewed. Twelve patients (1.6%) suffered a bronchopleural fistula, of whom 5 died because of this complication (mortality rate, 41.7%). Multivariate analysis revealed squamous cell carcinoma, preoperative chemotherapy, lower lobectomy, and middle and lower lobectomy were risk factors for bronchopleural fistula. In such cases, particular care must be exercised to maintain blood flow through the bronchial stump during surgery, and reinforcement, such as stump coverage, must be employed.

Long-term outcomes and risk factor analysis after pneumonectomy for active and sequela forms of pulmonary tuberculosis.

The prevalence of pulmonary tuberculosis remains high in several areas of the world, and pneumonectomy is often necessary to treat the disease. We retrospectively analyzed the morbidities, mortalities, and long-term outcomes after pneumonectomy for the treatment of active tuberculosis or its sequelae. Between 1981 and 2001, 94 patients underwent either pneumonectomy or pleuropneumonectomy for the treatment of tuberculosis. The patients included 44 males and 50 females and the mean age was 40 (16-68) years. The pathology included destroyed lung in 80, main bronchus stenosis in ten, and both lesions in four. Surgical procedures performed were pneumonectomy in 47, pleuropneumonectomy in 43, and completion pneumonectomy in four. One patient died postoperatively due to empyema. Twenty-three complications occurred in 20 patients: empyema in 15 (including seven bronchopleural fistulae), wound infections in five, and other complications in three. Univariate analysis revealed the presence of empyema, pleuropneumonectomy, prolonged operation time, old age, and intraoperative contamination as risk factors of postpneumonectomy empyema; it also showed that low preoperative FEV(1) and postoperative persistent positive sputum AFB were risk factors of bronchopleural fistula. In multivariate analysis, old age and low preoperative FEV(1) were risk factors of empyema while low preoperative FEV(1), positive sputum acid-fast bacilli, and the presence of aspergilloma were risk factors of bronchopleural fistula. There were 12 late deaths. Actuarial 5- and 10-year survival rates were 94+/-3% and 87+/-4%, respectively. Pneumonectomy could be performed with acceptable mortality and morbidity, and could achieve satisfactory long-term survival for the treatment of tuberculosis. In patients with risk factors, special care is recommended to prevent postoperative empyema or bronchopleural fistula.

Postpneumonectomy bronchopleural fistula after sutured bronchial closure: Incidence, risk factors, and management

Objective: Postpneumonectomy bronchopleural fistula remains a morbid complication after pneumonectomy. The incidence, risk factors, and management of postpneumonectomy bronchopleural fistula were evaluated in 256 consecutive patients who underwent pneumonectomy with a standardized suture closure of the bronchus. Methods: Pneumonectomy was performed for lung cancer in 198 cases, for other malignancy in 20 cases, and for benign causes in 38 cases. The bronchial stump was closed with interrupted simple sutures to emphasize a long, membranous wall flap. All stumps were covered by autologous tissue. Results: The incidence of postpneumonectomy bronchopleural fistula was 3.1%. Risk factors for bronchopleural fistula were the need for postoperative ventilation ( p = 0.0001) and right pneumonectomy ( p = 0.04). Five patients had bronchopleural fistulas as a result of pulmonary complications necessitating ventilation; the cause in the remaining three cases appeared to be technical. Reclosure was successful in five cases (mean postoperative day 12); in one case a pinhole fistula was healed by drainage alone. Two (25%) of the eight patients who had bronchopleural fistulas died. Conclusions: Careful, sutured closure of the main bronchus with a tissue buttress after pneumonectomy yields excellent results. The most significant risk factor for bronchopleural fistula is a pulmonary complication necessitating ventilation. Contrary to previous reports, reclosure is usually successful even if performed late. (J T HORAC C ARDIOVASC S URG 1996;112:1367-71)

Bronchopleural fistulas associated with lung cancer operations: Univariate and multivariate analysis of risk factors, management, and outcome

During a 28-year period, 52 bronchopleural fistulas developed after pulmonary resection of 49 primary and three recurrent lung cancers at the National Cancer Center Hospital, Tokyo. During the same period there were 2359 pulmonary resections for primary lung cancer; the prevalence of bronchopleural fistula was 2.1%. Multivariate analysis on 15 variables in the most recent 1360 resections revealed significant risk factors for bronchopleural fistula: wider resection such as pneumonectomy, residual carcinomatous tissue at the bronchial stump, preoperative irradiation, and diabetes. Univariate analysis further recognized a risk in preoperative bronchial arterial infusion and the postsurgical stage of lung cancer. Six patients were not treated. Apart from chest tube drainage in seven patients, surgical repair was attempted in 39, direct resuture of the stump in 16, wrapping in 25, thoracoplasty in 31, completion pneumonectomy in 6, and other treatments. Despite various treatments, 37 patients (71.2% mortality) died from fistula-related complications (such as regurgitation of infected pleural fluid through the fistula and airway/intrathoracic bleeding). Even for patients whose fistulas were cured and who were discharged, the average hospital stay was 189 days. Further investigation is necessary to answer whether prevention by flap coverage is of any benefit.