Risk factors for bronchopleural fistula after right pneumonectomy: Does eliminating the stump diverticulum provide protection?

Thomas Birdas, Mohamed H. Morad, Ikenna C. Okereke, Karen Rieger, Laura E. Kruter, Praveen N. Mathur, Kenneth Kesler

Research output: Contribution to journalArticle

15 Citations (Scopus)

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 languageEnglish
Pages (from-to)1336-1342
Number of pages7
JournalAnnals of Surgical Oncology
Volume19
Issue number4
DOIs
StatePublished - Apr 2012

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Pneumonectomy
Diverticulum
Fistula
Logistic Models
Radiation
Mortality
Non-Small Cell Lung Carcinoma
Medical Records
Ventilation
Drainage
Radiotherapy
Multivariate Analysis
Databases
Drug Therapy

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; Morad, Mohamed H.; Okereke, Ikenna C.; Rieger, Karen; Kruter, Laura E.; Mathur, Praveen N.; Kesler, Kenneth.

In: Annals of Surgical Oncology, Vol. 19, No. 4, 04.2012, p. 1336-1342.

Research output: Contribution to journalArticle

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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.",
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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.

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