Analysis of risk factors for postpneumonectomy bronchopleural fistulas in patients with lung cancer.
BACKGROUND
Bronchopleural fistula is a potentially fatal complication of pulmonary resections, especially pneumonectomy.


METHODS
Univariate and multivariate analyses of the development of bronchopleural fistula were performed in 12 patients with bronchopleural fistula and 102 patients without bronchopleural fistula who had undergone pneumonectomy from January 1983 through December 2005.


RESULTS
Bronchopleural fistula developed after pneumonectomy in 12 patients (8.5%). Seven (58.7%) of the 12 patients died of bronchopleural fistula. Univariate analysis showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease significantly contributed to the development of postpneumonectomy bronchopleural fistula (p=0.0002, p=0.0043, and p=0.0387, respectively). Multivariate analysis also showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease were significant risk factors for postpneumonectomy bronchopleural fistula.


CONCLUSIONS
Bronchopleural fistula is strongly associated with preoperative infection, right pneumonectomy, and pathological N2, 3 disease. Bronchial stump coverage with pedicled tissue flaps and preservation of the bronchial arteries during mediastinal lymph node dissection are recommended to maintain the blood supply to the bronchial stump in patients at risk.
Haraguchi
Shuji
S
Department of Surgery, Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan. shuji@nms.ac.jp
Koizumi
Kiyoshi
K
Hioki
Masafumi
M
Hirata
Tomomi
T
Hirai
Kyoji
K
Mikami
Iwao
I
Kubokura
Hirotoshi
H
Enomoto
Yutaka
Y
Kinoshita
Hiroyasu
H
Shimizu
Kazuo
K
D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005402:Fistula / Q000209:etiology*; D006801:Humans; D007239:Infections / Q000150:complications; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010995:Pleural Diseases / Q000453:epidemiology / Q000209:etiology*; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors