Postoperative ischemic bronchitis after lymph node dissection and primary lung cancer resection.
BACKGROUND
The purpose of this study was to determine the incidence and symptoms of postoperative ischemic bronchitis (POIB) after systematic lymph node dissection (LND) and evaluate the effect of hyperbaric oxygen therapy in patients with primary lung cancer.


METHODS
From January 2004 to December 2009, 1,071 patients underwent a standard resection for non-small cell lung cancer and radical systematic lymph node dissection. Fiberoptic bronchoscopy was performed systematically between days 7 and 12. We analyzed the clinical and biologic signs of POIB. Once the diagnosis established a treatment by hyperbaric oxygen, therapy was undertaken.


RESULTS
A POIB was observed in 34 patients (3.21%) (2 women and 32 men). Mean age was 59 ± 10 years (range, 25 to 79 years). A POIB occurred within 8 ± 3 days; after right pulmonary resection (n = 21; 62%) and after left resection (n = 13; 38%). A POIB appeared asymptomatically for 27 patients (80%), whereas only 7 patients (20%) presented with fever and hyperleukocytosis. Their localization were bronchial stumps (n = 21; 62%), homolateral bronchial tree (n = 11; 32%), or extension toward the contralateral bronchial tree (n = 2; 6%). The mean number of hyperbaric oxygen therapy sessions was 14 (1 to 48). A POIB worsening was observed in 6 patients (18%), requiring a surgical rescue therapy.


CONCLUSIONS
The clinical presentation of POIB is poor and systematic fiberoptic bronchoscopy should be performed, especially in patients with a high risk of bronchopleural fistula. Hyperbaric oxygen therapy in the management of ischemic bronchitis may be a promising adjunctive treatment.
Department of Thoracic Surgery, Albert Calmette Hospital, University Hospital of Lille, Lille, France. mohamedlotfi-benhamed@chru-lille.fr
Lotfi
L
Benhamed
Jocelyn
J
Bellier
Clément
C
Fournier
Rias
R
Akkad
Daniel
D
Mathieu
Eric
E
Kipnis
Henri
H
Porte
D000328:Adult; D000368:Aged; D001980:Bronchi / Q000098:blood supply; D001991:Bronchitis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D001999:Bronchoscopy; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D015994:Incidence; D007511:Ischemia / Q000453:epidemiology* / Q000209:etiology; D008175:Lung Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology