title: Residual disease at the bronchial stump is positively associated with the risk of bronchoplerual fistula in patients undergoing lung cancer surgery: a meta-analysis.
abstract: OBJECTIVE
  Residual disease at the bronchial stump (RDBS) is regarded as an important factor possibly resulting in bronchopleural fistula (BPF) after lung cancer surgery, but this has not been confirmed. We conducted this meta-analysis to evaluate the effects of RDBS on BPF formation in patients undergoing lung cancer surgery.
  
  
  METHODS
  PubMed and EMBASE databases were searched for full-text articles that met our eligibility criteria. Odds ratios (ORs) with 95% confidence interval (95% CI) served as the summarized outcomes. Q-test and I(2) statistic were used to evaluate the level of heterogeneity, determining the fixed-effect model or random-effect model for quantitative synthesis. Sensitivity analysis was conducted to identify the possible origins of heterogeneity. The publication bias was assessed by Begg's test.
  
  
  RESULTS
  A total of eight retrospective observational studies were included in our meta-analysis. In overall analysis, the pooled outcomes indicated that RDBS was significantly associated with BPF formation after lung cancer surgery (OR: 3.12; 95% CI: 1.72-5.64; P < 0.001). In subgroup analysis, the pooled outcomes revealed a significantly increased risk of post-pneumonectomy BPF in patients with RDBS (OR: 2.78; 95% CI: 1.06-7.28; P = 0.037). The subgroup analysis assessing the effects of RDBS on post-lobectomy BPF was given up due to the scarcity of available data. No heterogeneity was revealed within this meta-analysis. No evidence for publication bias was detected by Begg's test.
  
  
  CONCLUSIONS
  Our meta-analysis indicates that RDBS is positively associated with the increased risk of BPF in patients undergoing lung cancer surgery. The further analysis also reveals an increased risk of post-pneumonectomy BPF in patients with RDBS. More accurate and comprehensive evidence should be collected and summarized in updated meta-analyses.
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Shuangjiang
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Fan
authors.affiliation: Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yutao
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Shen
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China guowei_che@yahoo.com.
authors.forename: Guowei
authors.initials: G
authors.lastname: Che
mesh_terms: D001980:Bronchi / Q000473:pathology / Q000601:surgery*; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual; D016017:Odds Ratio; D010995:Pleural Diseases / Q000175:diagnosis / Q000209:etiology*; D011013:Pneumonectomy / Q000009:adverse effects*; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Bronchial stump; Bronchopleural fistula; Lung cancer surgery; Meta-analysis; Residual disease