Management of the irradiated bronchus after lobectomy for lung cancer.
BACKGROUND
Radiation effects make operative dissection difficult, impair subsequent healing, and increase morbidity. This study evaluates tissue reinforcement of the irradiated bronchus as a modality to reduce morbidity after lobectomy for lung cancer.


METHODS
We retrospectively reviewed all patients who had preoperative radiotherapy before lobectomy for lung cancer between May 1977 and June 2000.


RESULTS
There were 56 patients (33 men and 23 women) who ranged in age from 42 to 80 years (median, 59 years). Bronchial stump reinforcement included no coverage in 24 patients (42.8%), mediastinal tissue (parietal pleura, pericardial fat, or azygos vein) in 16 (28.6%), and muscle (serratus anterior) in 16 (28.6%). Median preoperative radiation dose was 4,600 cGy (range, 3,000 to 9,810 cGy) and did not differ between the groups. There were three deaths (13%) in the no coverage group, one (6%) in the mediastinal tissue group, and one (6%) in the muscle group (NS). Pulmonary complication rate was 67% in the no coverage group, 44% in the mediastinal group, and 25% in the muscle group (p = 0.03). Median duration of chest tube drainage was 8 days in the no coverage group, 6 days in the mediastinal group, and 5 days in the muscle group (p = 0.006). Median hospital stay was 13 days in the no coverage group, 9 days in the mediastinal group, and 7 days in the muscle group (p = 0.02). Patients in the muscle group had reduced hospital stay, duration of chest tube drainage, and pulmonary complications compared with the other two groups (p < 0.05). Subjectively, presence and magnitude of postoperative pain, range of motion, and strength of the upper extremity of the muscle flap side were not different between the groups (p = NS). Follow-up was complete and ranged from 4 to 147 months (median, 17 months).


CONCLUSIONS
Tissue reinforcement of the irradiated bronchus after lobectomy reduces postoperative morbidity and hospitalization. Transposition muscle flap may be preferred.
Greason
Kevin L
KL
Division of Cardiothoracic Surgery, Naval Medical Center, San Diego, California, USA.
Miller
Daniel L
DL
Clay
Ricky P
RP
Deschamps
Claude
C
Johnson
Craig H
CH
Allen
Mark S
MS
Trastek
Victor F
VF
Pairolero
Peter C
PC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000528:radiation effects* / Q000601:surgery; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000517:prevention & control; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods; D015995:Prevalence; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000175:diagnosis / Q000453:epidemiology*; D011877:Radionuclide Imaging; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D012016:Reference Values; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome