Risk Factors for Bronchopleural Fistula after Pneumonectomy: Stump Size Does Matter

Abstract

Objective: Side- and sex-related differences were analysed to explain the occurrence of bronchopleural fistula (BPF) after pneumonectomy on the right-hand side in men. Patients and Methods: Surgical pathology reports on 209 patients (15 with BPF) were retrospectively reviewed regarding sex, age, side, TNM stage, outer diameter of the resection margin (mm) and intrabronchial distance between tumour and resection margin (mm). Patients without macroscopic bronchial invasion were categorised as peripheral tumours. The t-test, U-test (Mann-Whitney) and cross-tabulation using the χ²-test were performed for univariate statistical analysis. A logistic stepwise backwards regression model was used for multivariate analysis. Results: Women were significantly younger than men, had a smaller resection margin and fewer central tumours. Stage 4 was overrepresented in women, stage 2 in men. On the right-hand side, the distance was significantly shorter, the resection margin longer and the patients younger. Fistula patients showed a longer resection margin and a shorter distance, men were dominant. Multivariate analysis only identified length of the resection margin as an independent risk factor for BPF (p = 0.024, OR 1.177 CI: 1.033 - 1.356). Gender and side significantly influenced the diameter of the resection margin (p = 0.00). Conclusion: The diameter of the bronchial stump is a major risk factor in the occurrence of post-pneumonectomy BPF, and explains the predominance of the male sex, the right-hand side and pneumonectomy. Where it exceeds 25 mm, prophylactic stump coverage with viable tissue should be performed.

Key words

bronchopleural fistula - pneumonectomy - risk factor - postoperative complication

References

• 1 Smith L, Parnsingha T. Post irradiation surgery for bronchogenic carcinoma.  Thorax. 1969;  24 457-460
• 2 Sonobe M, Nakagawa M, Ichinose M, Ikegami N, Nagasawa M, Shindo T. Analysis of risk factors for bronchopleural fistula after pulmonary resections for primary lung cancer.  Eur J Cardiothorac Surg. 2000;  18 519-523
• 3 Linberg E J, Cowley R A, Bloedron F, Wizenberg M J. Bronchogenic carcinoma: further experience with preoperative irradiation.  Ann Thorac Surg. 1965;  1 371-374
• 4 Asamura H, Naruke T, Tsuchyia R, Goya T, Kondo H, Suemasu K. Bronchopleural fistulas associated with lung cancer operations.  J Thorac Cardiovasc Surg. 1992;  104 1456-1464
• 5 Gall S A, Wolfe G W. Management of microfistula following resection.  Chest Surg Clin North America. 1996;  6 553-565
• 6 Williams N S, Lewis C T. Bronchopleural fistula: a review of 86 cases.  Br J Surg. 1976;  63 520-522
• 7 Lynn R B. The bronchus stump.  J Thoracic Surg. 1958;  36 70-75
• 8 Bruni F. Treatment of lung stump after pneumonectomy. In: Grillo H, Eschapasse H (eds) International trends in general thoracic surgery, vol 2 Major challenges. Philadelphia; WB Saunders 1987: 413-421
• 9 Rienhoff W F, Gannon J, Sherman I. Closure of the bronchial stump following total pneumonectomy.  Ann Surg. 1942;  116 481
• 10 Dienemann H, Trainer C, Hoffmann H. et al . Inkomplette Resektion bei Bronchialkarzinom: Morbidität und Prognose.  Chirurg. 1997;  68 1014-1019
• 11 Heikkila L, Harjula A. Suomaleinen RJ, Mattila P, Mattila S. Residual carcinoma in bronchial resection line.  Ann Chir Gynaecol. 1986;  75 151-154