title: Postpneumonectomy bronchial stump recurrence and bronchopleural fistula.
abstract: OBJECTIVE
  To reduce the incidence of postpneumonectomy local recurrence, and to prevent the onset of bronchopleural fistula.
  
  
  BACKGROUND
  A long bronchial stump with a short tumor-free bronchial margin has been found to be associated with a higher incidence of local recurrence, and with the development of bronchopleural fistula in some cases.
  
  
  METHODS
  134 patients underwent pneumonectomy for non-small-cell lung cancer in 2 institutions. Bronchial stump length was measured intra-and postoperatively.
  
  
  RESULTS
  30-day postoperative mortality was 2.9%. There were 3 postoperative bronchopleural fistulas after right pneumonectomy (3/61) and one after left pneumonectomy (1/73; p=0.2; fistula was more frequent in the long-stump group), which were successfully treated with carina sutures in 75% of cases. The overall incidence of local recurrence was strongly related to the presence of tumoral microinvasion in the resection margin (100%).
  
  
  CONCLUSIONS
  To prevent postpneumonectomy bronchial stump complications, it might be useful to use carina closure instead of bronchial closure. Carina closure can reduce local recurrence, significantly reduce the fistulization rate, and eliminate the stump diverticulum. Reduction of the length of the bronchial stump can be achieved using a TA Roticulator linear stapler.
authors.affiliation: General Surgery, San Martino, IST, University Hospital, Via Fratelli Coda 67/5 sc. a. Genoa 16166, Italy. andrea.cariati@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Cariati
authors.forename: Elisa
authors.initials: E
authors.lastname: Piromalli
authors.forename: Mario
authors.initials: M
authors.lastname: Taviani
mesh_terms: D000368:Aged; D001983:Bronchial Fistula / Q000209:etiology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000150:complications*; D010995:Pleural Diseases / Q000209:etiology*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods*; D016156:Respiratory Tract Fistula / Q000209:etiology*