title: The role of muscle flap in preventing bronchus stump insufficiency after pneumonectomy for malignant pleural mesothelioma in high-risk patients.
abstract: Bronchus stump insufficiency (BSI) is one of the major complications after pneumonectomy; we analyzed all patients who underwent extra pleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM) in order to detect the role of muscle flap (MF) on preventing early and late stump insufficiency. From January 2000 until December 2005, there were 42 patients admitted with MPM for further intervention at our institution. Thirty patients were suitable for surgery and thus received a multimodal treatment with neo-adjuvant chemotherapy using Cisplatin and Gemcitabin (Gemzar), EPP followed by 54 Gray (Gy) adjuvant radiotherapy. Data were collected from the surgical and oncological records. There were 37 male patients (88%), the median age was 65 years (range 40-83 years). Seven (17%) patients had concomitant diseases. Forty patients (95%) had asbestos exposition. The operative procedures were EPP with muscle flap through an anterolateral thoracotomy. Univariate and multivariate analyses were done. One patient (3%) died on the 2nd postoperative day due to lung embolism. Mild complications were noticed in the early postoperative phase in 8 (25%) patients. There was no early or late stump insufficiency during the 15-month follow-up. Surgical techniques using muscle flap seems to play a major role in the prevention of bronchus stump insufficiency especially after neo-adjuvant chemotherapy.
authors.affiliation: Division of General Thoracic Surgery, University Hospital of Berne, Switzerland. morris.beshay@evkb.de
authors.forename: Morris
authors.initials: M
authors.lastname: Beshay
authors.forename: Giovanni
authors.initials: G
authors.lastname: Carboni
authors.forename: Beatrix
authors.initials: B
authors.lastname: Hoksch
authors.forename: Marc A
authors.initials: MA
authors.lastname: Reymond
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Schmid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001982:Bronchial Diseases / Q000209:etiology / Q000517:prevention & control*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D020360:Neoadjuvant Therapy; D010997:Pleural Neoplasms / Q000401:mortality / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013524:Surgical Flaps; D013908:Thoracotomy; D016896:Treatment Outcome