title: Clinical value of exogenous factor XIII for prolonged air leak following pulmonary lobectomy: a case control study.
abstract: BACKGROUND
  We examined the effect of exogenous factor XIII (FXIII) concentrate in patients with prolonged air leak (PAL) after pulmonary lobectomy for non-small cell lung cancer.
  
  
  METHODS
  We performed a retrospective analysis of 297 patients who underwent pulmonary lobectomy between July 2007 and March 2014: 90 had an air leak on the first postoperative day, which resolved spontaneously within 5 days in 53 cases (SR group). FXIII concentrate was administered to the remaining 37 patients (PAL group) for 5 days. This group was subdivided into those in whom the air leak resolved during FXIII treatment (EF group) and those who needed additional intervention (inEF group). The clinical and perioperative characteristics of the groups were compared.
  
  
  RESULTS
  Although plasma FXIII activity did not differ significantly between the SR and PAL groups before surgery or on the fifth postoperative day, the proportional perioperative fall in FXIII activity was significantly greater in the SR group (33%) than the PAL group (22%, p = 0.044) and inEF group (14%, p = 0.048). On the fifth postoperative day, FXIII activity was significantly lower in the EF group than in the inEF group (74% versus 91%, p = 0.030). The optimal cut-off point for postoperative plasma FXIII activity to distinguish between the EF and inEF groups was 86%.
  
  
  CONCLUSIONS
  Insufficient plasma FXIII consumption and lower postoperative FXIII activity may play a role in the resolution of PAL, and exogenous FXIII concentrate may be an effective, safe and non-invasive treatment.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. m1364552@msic.med.osaka-cu.ac.jp.
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Shinjiro
authors.initials: S
authors.lastname: Mizuguchi
authors.forename: Koshi
authors.initials: K
authors.lastname: Nagano
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Izumi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Komatsu
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D016022:Case-Control Studies; D005176:Factor XIII / Q000378:metabolism / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D016156:Respiratory Tract Fistula / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005176:Factor XIII