title: Is the Isolated Pericardial Fat Pad Sufficient to Cover the Bronchial Stump and Separate the Pulmonary Artery in Order to Prevent Bronchopleural Fistula in Patients with Lung Cancer?
abstract: BACKGROUND
  The development of a bronchopleural fistula (BPF) is the most serious postoperative complication of thoracic surgery. All surgical techniques that have been reported as preventive measures against BPF have disadvantages.
  
  
  METHODS
  We herein introduce a new technique (Yatsuhashi method) for covering the bronchial stump after right lower lobectomy using isolated pericardial fat tissue (PFT). Between 2012 and 2015, 878 consecutive patients with lung disease underwent surgery at our Institution. Among these patients, 26 underwent right lower lobectomy. Their clinical records were retrospectively reviewed to identify the presence of residual fat, in patients in whom the traditional pedicle method was applied and in those in whom an isolated PFT method was applied. The data on the characteristics, surgical details, and perioperative outcomes were analyzed.
  
  
  RESULTS
  There were no cases of BPF and the 90-day mortality rate was 0%. The mean period of time from the day of surgery until the computed tomographic examination was 207 days. There were no significant differences in the age, gender, clinical stage, pathological stage, the presence of comorbidities or complications, the duration until computed tomography, nor the presence of residual fat between the patients in whom the isolated PFT (n=17) and the standard pedicle (n=9) methods were applied. Furthermore, no postoperative complications due to the use of isolated PFT itself were observed in the patients who were treated using this method. The existence of residual isolated PFT was also confirmed in five out of six cases who underwent surgical treatment with the novel Yatsuhashi method.
  
  
  CONCLUSIONS
  The simple technique using PFT for covering the bronchial stump after right lower lobectomy was satisfactorily effective and was not associated with any complications.
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan Division of Thoracic Surgery, Kanazawa Medical University, Uchinada, Japan hidetaka@cancer-c.pref.saitama.jp.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Uramoto
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000273:Adipose Tissue / Q000503:physiopathology*; D000368:Aged; D001983:Bronchial Fistula / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D010496:Pericardium / Q000503:physiopathology*; D010995:Pleural Diseases / Q000150:complications / Q000517:prevention & control*; D011651:Pulmonary Artery / Q000503:physiopathology*
keywords: BPF; Pericardial fat pad; lung cancer; surgery