Abstract
Purpose. Bronchopleural fistula (BPF) remains an important source ofmorbidity andmortality after right pneumonectomy. We reviewed our 18-year institutional experience with right pneumonectomy to identify risks factors for BPF. Methods. From 1992 to 2010, a total of 145 patients who underwent right pneumonectomy were identified from an institutional database. Median age was 56 years. Most patients (66.2%) underwent surgery for non-small cell lung cancer. Sixty-seven patients (46.2%) received either chemotherapy or radiotherapy before surgery. Medical records were reviewed for 14 variables potentially predictive for BPF, including two airway closure techniques (standard bronchial closure and carinal closure). Variables predictive of BPF by univariate analysis were entered into a logistic regression model. Results. The overall mortality rate was 13.1% (n = 19), with 15.9 and 10.5% mortality in the bronchial closure and carinal closure groups, respectively (P = 0.33). The overall BPF rate was 7.6% (n = 11), with a 3.9% (3 of 76) rate in the carinal closure group compared to 11.6% (8 of 69) in the bronchial closure group (P = 0.08). Seven of eight bronchial closure patients who developed BPF required operative repair. Only one of three patients who developed BPF after carinal closure did not spontaneously heal after open drainage. Multivariate analysis identified preoperative radiation dose (P = 0.042) and bronchial closure (P = 0.041) as independent risk factors for BPF, while the length of postoperative ventilation before development of BPF approached significance (P = 0.057). Conclusions. In our experience, higher preoperative radiation doses are a risk factor for BPF after right pneumonectomy, while carinal closure exerts a protective effect.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1336-1342 |
| Number of pages | 7 |
| Journal | Annals of Surgical Oncology |
| Volume | 19 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2012 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Surgery
- Oncology
Cite this
Risk factors for bronchopleural fistula after right pneumonectomy : Does eliminating the stump diverticulum provide protection? / Birdas, Thomas J.; Morad, Mohamed H.; Okereke, Ikenna; Rieger, Karen M.; Kruter, Laura E.; Mathur, Praveen N.; Kesler, Kenneth A.
In: Annals of Surgical Oncology, Vol. 19, No. 4, 04.2012, p. 1336-1342.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Risk factors for bronchopleural fistula after right pneumonectomy
T2 - Does eliminating the stump diverticulum provide protection?
AU - Birdas, Thomas J.
AU - Morad, Mohamed H.
AU - Okereke, Ikenna
AU - Rieger, Karen M.
AU - Kruter, Laura E.
AU - Mathur, Praveen N.
AU - Kesler, Kenneth A.
PY - 2012/4
Y1 - 2012/4
N2 - Purpose. Bronchopleural fistula (BPF) remains an important source ofmorbidity andmortality after right pneumonectomy. We reviewed our 18-year institutional experience with right pneumonectomy to identify risks factors for BPF. Methods. From 1992 to 2010, a total of 145 patients who underwent right pneumonectomy were identified from an institutional database. Median age was 56 years. Most patients (66.2%) underwent surgery for non-small cell lung cancer. Sixty-seven patients (46.2%) received either chemotherapy or radiotherapy before surgery. Medical records were reviewed for 14 variables potentially predictive for BPF, including two airway closure techniques (standard bronchial closure and carinal closure). Variables predictive of BPF by univariate analysis were entered into a logistic regression model. Results. The overall mortality rate was 13.1% (n = 19), with 15.9 and 10.5% mortality in the bronchial closure and carinal closure groups, respectively (P = 0.33). The overall BPF rate was 7.6% (n = 11), with a 3.9% (3 of 76) rate in the carinal closure group compared to 11.6% (8 of 69) in the bronchial closure group (P = 0.08). Seven of eight bronchial closure patients who developed BPF required operative repair. Only one of three patients who developed BPF after carinal closure did not spontaneously heal after open drainage. Multivariate analysis identified preoperative radiation dose (P = 0.042) and bronchial closure (P = 0.041) as independent risk factors for BPF, while the length of postoperative ventilation before development of BPF approached significance (P = 0.057). Conclusions. In our experience, higher preoperative radiation doses are a risk factor for BPF after right pneumonectomy, while carinal closure exerts a protective effect.
AB - Purpose. Bronchopleural fistula (BPF) remains an important source ofmorbidity andmortality after right pneumonectomy. We reviewed our 18-year institutional experience with right pneumonectomy to identify risks factors for BPF. Methods. From 1992 to 2010, a total of 145 patients who underwent right pneumonectomy were identified from an institutional database. Median age was 56 years. Most patients (66.2%) underwent surgery for non-small cell lung cancer. Sixty-seven patients (46.2%) received either chemotherapy or radiotherapy before surgery. Medical records were reviewed for 14 variables potentially predictive for BPF, including two airway closure techniques (standard bronchial closure and carinal closure). Variables predictive of BPF by univariate analysis were entered into a logistic regression model. Results. The overall mortality rate was 13.1% (n = 19), with 15.9 and 10.5% mortality in the bronchial closure and carinal closure groups, respectively (P = 0.33). The overall BPF rate was 7.6% (n = 11), with a 3.9% (3 of 76) rate in the carinal closure group compared to 11.6% (8 of 69) in the bronchial closure group (P = 0.08). Seven of eight bronchial closure patients who developed BPF required operative repair. Only one of three patients who developed BPF after carinal closure did not spontaneously heal after open drainage. Multivariate analysis identified preoperative radiation dose (P = 0.042) and bronchial closure (P = 0.041) as independent risk factors for BPF, while the length of postoperative ventilation before development of BPF approached significance (P = 0.057). Conclusions. In our experience, higher preoperative radiation doses are a risk factor for BPF after right pneumonectomy, while carinal closure exerts a protective effect.
UR - http://www.scopus.com/inward/record.url?scp=84862504532&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862504532&partnerID=8YFLogxK
U2 - 10.1245/s10434-011-2119-z
DO - 10.1245/s10434-011-2119-z
M3 - Article
C2 - 22045468
AN - SCOPUS:84862504532
VL - 19
SP - 1336
EP - 1342
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
SN - 1068-9265
IS - 4
ER -