Bronchopleural fistula after pneumonectomy: Risk factors and management, focusing on open window thoracostomy

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To evaluate principal risk factors and different therapeutic approaches for postpneumonectomy bronchopleural fistula (BPF), focusing on open window thoracostomy (OWT). Methods: We retrospectively reviewed all patients treated by pneumonectomy for lung cancer between 1999 and 2014. We evaluated preoperative, operative, and postoperative data; interval between operation and fistula formation; and size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log-rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. A P value < .05 was considered statistically significant. Results: BPF occurred in 60 of 733 patients (8.2%). Bronchial suture with a stapler (Endo GIA; P = .02), right side (P = .003), and low preoperative albumin levels (<3.5 g/dL; P = .02) were independent predictive factors. Early BPF was treated by thoracotomic (n = 12) or thoracoscopic (n = 2) debridement of necrotic tissue and BPF surgical repair. Late BPF was treated by bronchoscopic application of fibrin glue (n = 3) or endobronchial stent (n = 1), or chest tube and cavity irrigation with povidone-iodine (n = 15). OWT was performed in 27 patients, followed by muscle flap interposition in 7 of these 27. The median survival time of patients after treatment for BPF was 29.0 months. Overall survival in the patients treated with OWT was 50% at 2 years and 27 (8%) at 4 years. Conclusions: Optimal management of BPF depends on several factors. In the event of failure of an initial therapeutic approach, OWT, followed by myoplasty, may be considered.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
Publication statusAccepted/In press - Jan 1 2017

Fingerprint

Thoracostomy
Pneumonectomy
Risk Management
Fistula
Povidone-Iodine
Chest Tubes
Fibrin Tissue Adhesive
Survival
Debridement
Therapeutics
Sutures
Stents
Albumins
Lung Neoplasms

Keywords

  • Bronchopleural fistula
  • Lung cancer
  • Open window thoracostomy
  • Pneumonectomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{d64e61fa6c334c48b8bd271836c4df67,
title = "Bronchopleural fistula after pneumonectomy: Risk factors and management, focusing on open window thoracostomy",
abstract = "Objective: To evaluate principal risk factors and different therapeutic approaches for postpneumonectomy bronchopleural fistula (BPF), focusing on open window thoracostomy (OWT). Methods: We retrospectively reviewed all patients treated by pneumonectomy for lung cancer between 1999 and 2014. We evaluated preoperative, operative, and postoperative data; interval between operation and fistula formation; and size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log-rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. A P value < .05 was considered statistically significant. Results: BPF occurred in 60 of 733 patients (8.2{\%}). Bronchial suture with a stapler (Endo GIA; P = .02), right side (P = .003), and low preoperative albumin levels (<3.5 g/dL; P = .02) were independent predictive factors. Early BPF was treated by thoracotomic (n = 12) or thoracoscopic (n = 2) debridement of necrotic tissue and BPF surgical repair. Late BPF was treated by bronchoscopic application of fibrin glue (n = 3) or endobronchial stent (n = 1), or chest tube and cavity irrigation with povidone-iodine (n = 15). OWT was performed in 27 patients, followed by muscle flap interposition in 7 of these 27. The median survival time of patients after treatment for BPF was 29.0 months. Overall survival in the patients treated with OWT was 50{\%} at 2 years and 27 (8{\%}) at 4 years. Conclusions: Optimal management of BPF depends on several factors. In the event of failure of an initial therapeutic approach, OWT, followed by myoplasty, may be considered.",
keywords = "Bronchopleural fistula, Lung cancer, Open window thoracostomy, Pneumonectomy",
author = "Antonio Mazzella and Alessandro Pardolesi and Patrick Maisonneuve and Francesco Petrella and Domenico Galetta and Roberto Gasparri and Lorenzo Spaggiari",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.jtcvs.2017.05.105",
language = "English",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Bronchopleural fistula after pneumonectomy

T2 - Risk factors and management, focusing on open window thoracostomy

AU - Mazzella, Antonio

AU - Pardolesi, Alessandro

AU - Maisonneuve, Patrick

AU - Petrella, Francesco

AU - Galetta, Domenico

AU - Gasparri, Roberto

AU - Spaggiari, Lorenzo

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objective: To evaluate principal risk factors and different therapeutic approaches for postpneumonectomy bronchopleural fistula (BPF), focusing on open window thoracostomy (OWT). Methods: We retrospectively reviewed all patients treated by pneumonectomy for lung cancer between 1999 and 2014. We evaluated preoperative, operative, and postoperative data; interval between operation and fistula formation; and size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log-rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. A P value < .05 was considered statistically significant. Results: BPF occurred in 60 of 733 patients (8.2%). Bronchial suture with a stapler (Endo GIA; P = .02), right side (P = .003), and low preoperative albumin levels (<3.5 g/dL; P = .02) were independent predictive factors. Early BPF was treated by thoracotomic (n = 12) or thoracoscopic (n = 2) debridement of necrotic tissue and BPF surgical repair. Late BPF was treated by bronchoscopic application of fibrin glue (n = 3) or endobronchial stent (n = 1), or chest tube and cavity irrigation with povidone-iodine (n = 15). OWT was performed in 27 patients, followed by muscle flap interposition in 7 of these 27. The median survival time of patients after treatment for BPF was 29.0 months. Overall survival in the patients treated with OWT was 50% at 2 years and 27 (8%) at 4 years. Conclusions: Optimal management of BPF depends on several factors. In the event of failure of an initial therapeutic approach, OWT, followed by myoplasty, may be considered.

AB - Objective: To evaluate principal risk factors and different therapeutic approaches for postpneumonectomy bronchopleural fistula (BPF), focusing on open window thoracostomy (OWT). Methods: We retrospectively reviewed all patients treated by pneumonectomy for lung cancer between 1999 and 2014. We evaluated preoperative, operative, and postoperative data; interval between operation and fistula formation; and size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log-rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. A P value < .05 was considered statistically significant. Results: BPF occurred in 60 of 733 patients (8.2%). Bronchial suture with a stapler (Endo GIA; P = .02), right side (P = .003), and low preoperative albumin levels (<3.5 g/dL; P = .02) were independent predictive factors. Early BPF was treated by thoracotomic (n = 12) or thoracoscopic (n = 2) debridement of necrotic tissue and BPF surgical repair. Late BPF was treated by bronchoscopic application of fibrin glue (n = 3) or endobronchial stent (n = 1), or chest tube and cavity irrigation with povidone-iodine (n = 15). OWT was performed in 27 patients, followed by muscle flap interposition in 7 of these 27. The median survival time of patients after treatment for BPF was 29.0 months. Overall survival in the patients treated with OWT was 50% at 2 years and 27 (8%) at 4 years. Conclusions: Optimal management of BPF depends on several factors. In the event of failure of an initial therapeutic approach, OWT, followed by myoplasty, may be considered.

KW - Bronchopleural fistula

KW - Lung cancer

KW - Open window thoracostomy

KW - Pneumonectomy

UR - http://www.scopus.com/inward/record.url?scp=85021939771&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021939771&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2017.05.105

DO - 10.1016/j.jtcvs.2017.05.105

M3 - Article

AN - SCOPUS:85021939771

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

ER -