Surgical management of late postpneumonectomy bronchopleural fistula: the transsternal, transpericardial route.
BACKGROUND
Late postpneumonectomy bronchopleural fistula (LBPF) is a serious complication. Surgical repair of the bronchial stump through a lateral thoracotomy is a dangerous attempt due to mediastinal fibrothorax and the risk of pulmonary artery stump damage.


OBJECTIVE
The goal of this study was to estimate the effectiveness of the transsternal, transpericardial approach for bronchial stump repair in case of LBPF.


METHODS
From 1996 to 2002, 1,294 lung resections for non-small cell lung cancer were performed at our department. Out of 412 pneumonectomies, 16 patients (3.8%) presented with LBPF after right pneumonectomy for non-small cell lung cancer. Thirteen of these patients were subjected to transsternal, transpericardial bronchial stump repair. They were followed postoperatively, and morbidity and mortality rates were recorded.


RESULTS
The interval between pneumonectomy and fistula diagnosis lasted from 12 to 85 months. The estimated sizes of the fistulae ranged from 5 to 21 mm, and the length of the bronchial stump was >1 cm only in 2 patients (15.3%).Due to persistent empyema, open-window thoracostomy was performed for definite treatment immediately after the operation for bronchial stump reamputation in 6 cases (46.1%). One patient (7.6%) died 3 months postoperatively due to bronchopleural fistula recurrence. This was also the only case of fistula recurrence.


CONCLUSIONS
LBPF usually needs definite management to save the patient's life. The transsternal, transpericardial approach is a safe and effective method.
Misthos
P
P
First Thoracic Surgical Department, Sotiria General Hospital for Chest Diseases, Athens, Greece. panmisthos@yahoo.gr
Kakaris
S
S
Sepsas
E
E
Athanassiadi
K
K
Skottis
I
I
D000368:Aged; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D002283:Carcinoma, Bronchogenic / Q000473:pathology / Q000601:surgery*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods*; D012008:Recurrence; D016019:Survival Analysis; D013907:Thoracostomy / Q000009:adverse effects* / Q000379:methods