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Analysis of Risk Factors for Postpneumonectomy Bronchopleural Fistulas in Patients with Lung Cancer
1Department of Surgery, Nippon Medical School Musashi Kosugi Hospital
2Division of Respiratory Surgery, Department of Surgery, Nippon Medical School
Background: Bronchopleural fistula is a poentioally fatal complication of pulmonary resections, especially pneumonectomy.
Methods: Univariate and multivariate analyses of the development of bronchopleural fistula were performed in 12 patients with bronchopleural fistula and 102 patients without bronchopleural fistula who had undergone pneumonectomy from January 1983 through December 2005.
Results: Bronchopleural fistula developed after pneumonecotomy in 12 patients (8.5%). Seven (58.7%) of the 12 patients died of bronchopleural fistula. Univariate analysis showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease significantly contributed to the development of postpneumonectomy bronchopleural fistula (p=0.0002, p=0.0043, and p=0.0387, respectively). Multivariate analysis also showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease were significant risk factors for postpneumonectomy bronchopleural fistula.
Conclusions: Bronchopleural fistula is strongly associated with preoperative infection, right pneumonectomy, and pathological N2, 3 disease. Bronchial stump coverage with pedicled tissue flaps and preservation of the bronchial arteries during mediastinal lymphnode dissection are recommended to maintain the blood supply to the bronchial stump in patients at risk.
J Nippon Med Sch 2006; 73: 314-319
Keywords
lung cancer, bronchopleural fistula, pneumonecotmy
Correspondence to
Shuji Haraguchi, MD, Department of Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan
shuji@nms.ac.jp
Received, August 30, 2006
Accepted, October 10, 2006
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