title: Incidence and Management of Post-Lobectomy and Pneumonectomy Bronchopleural Fistula.
abstract: BACKGROUND
  Bronchopleural fistula is a rare but potentially fatal complication of pulmonary resections and proper management is essential for its resolution. In this study, we analyzed the incidence of fistula after pulmonary resection and reported data about endoscopic and conservative treatments of this complication.
  
  
  METHODS
  From January 2003 to December 2013, 835 patients underwent anatomic lung resections: 786 (94.1 %) had a lobectomy and 49 (5.9 %) a pneumonectomy. Bronchopleural fistula was suspected by clinical signs and confirmed by endoscopic visualization.
  
  
  RESULTS
  Eighteen patients (2.2 %) developed a bronchopleural fistula, 11 in lobectomy group (1.4 %) and 7 in pneumonectomy group (14.3 %). The fistula size ranged between <1 mm and 6 mm and mean time of fistula onset was 33.9 ± 54.9 days after surgery. Of 18 patients who developed fistula, one died due to acute respiratory failure and another one was reoperated and then died to causes unrelated to the treatment. All the remaining 16 patients were treated with a conservative therapy that consisted in keeping or replacing a drainage chest tube. Nine of them underwent also endoscopic closure of the fistula using biological or synthetic glues. The mean period of time elapsed for the resolution of this complication was shorter with combined (conservative + endoscopic) than with conservative treatment alone (15.4 ± 13.2 vs. 25.8 ± 13.2 days, respectively), but without significant difference between the two methods (p: 0.299).
  
  
  CONCLUSIONS
  Endoscopic therapy, associated with a conservative treatment, is a safe and useful option in the management of the postoperative bronchopleural fistula.
authors.affiliation: Bronchoscopy and Pneumology Unit, Catholic University, Rome, Italy. leofuso@rm.unicatt.it.|Unità di Pneumologia, Università Cattolica S. Cuore, Largo A. Gemelli 8, 00168, Rome, Italy. leofuso@rm.unicatt.it.
authors.forename: Leonello
authors.initials: L
authors.lastname: Fuso
authors.affiliation: Bronchoscopy and Pneumology Unit, Catholic University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Varone
authors.affiliation: Thoracic Surgery Unit, Catholic University, Rome, Italy.
authors.forename: Dania
authors.initials: D
authors.lastname: Nachira
authors.affiliation: Bronchoscopy and Pneumology Unit, Catholic University, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Leli
authors.affiliation: Bronchoscopy and Pneumology Unit, Catholic University, Rome, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Salimbene
authors.affiliation: Thoracic Surgery Unit, Catholic University, Rome, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Congedo
authors.affiliation: Thoracic Surgery Unit, Catholic University, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
authors.affiliation: Thoracic Surgery Unit, Catholic University, Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Granone
mesh_terms: D000368:Aged; D001983:Bronchial Fistula / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D001999:Bronchoscopy; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D012384:Rome / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bronchopleural fistula; Bronchoscopy; Endoscopic treatment; Lobectomy; Pneumonectomy