Bronchopleural fistula after pneumonectomy for lung cancer.
Bronchopleural fistula (BPF) after pneumonectomy is a life-threatening complication. Over a period of 14 years (January 1980 to November 1993), 471 pneumonectomies were performed byone surgical team using a uniform suture technique for primary lung cancer. Non-small cell lung cancer accounted for 451 cases and 20 cases were small cell cancer. All operations were performed using a uniform hand suture technique. There were seven cases of BPF giving an incidence of 1.5%. All fistulas occurred within 15 days postoperatively and there were no late fistulas. The bronchial stump was free of tumor in all cases. No fistula occurred in the 24 (5.1%) completion pneumonectomies. The experience of the surgeon was important as the senior author performed 374 pneumonectomies with two fistulas (0.5%) while other surgeons in training performed 97 pneumonectomies with five fistulas (5.1%). Bronchial dehiscence was confirmed by bronchoscopy in all cases and an attempt at resuturing the stump through the same thoracotomy incision was made within 2 days of the diagnosis. Closure was successful in five patients, while the other two developed fatal complications. We conclude that suture closure to the bronchial stump after pneumonectomy provides a cheap and reliable technique, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk.
al-Kattan
K
K
King Khalid University Hospital, Riyadh, Saudi Arabia.
Cattelani
L
L
Goldstraw
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000209:etiology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies