Author of

• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12529

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    P3.07-034 - Therapeutic outcomes in 24 cases of postoperative bronchopleural fistula in lung cancer surgery (ID 2737)

    09:30 - 09:30  |  Author(s): K. Imai
    • Abstract

    Background
    Bronchopleural fistula (BPF) after lung resection is a life-threatening complication. Thoracic surgeons should always consider the risk of postoperative BPF and the management to avoid worst scenario, but it is still controversial of which is the best way to manage BPF. We herein describe the results of BPF and explore optimal treatment.

    Methods
    Data on 2270 patients with lung resection for NSCLC over a period from 2000 to 2012 were retrospectively reviewed. Details regarding surgery and subsequent treatment were carefully reviewed. Followed information was recorded; age, sex, clinical diagnosis, associated condition, TNM stage, time from primary operation to rethoracotomy, and postoperative outcome.

    Results
    The overall BPF incidence was 1.1% (24/2270). There were 20(83.3%) male and 4(16.7%) female, mean age was 67.1 years. BPFs occurred after pneumonectomy in 2(8.3%), lobectomy in 20 (83.3%) and sleeve resections in 2 (8.3%). In side right was in 20 (83.3%) and left was in 4 (16.7%). The histological types were 9 adenocarcinomas, 9 squamous cell carcinomas, 6 others. The pathological stage were stage IA in 6 cases, IB in 4, IIA in 3, IIB in 4, IIIA in 6 cases. Mean postoperative day was 19.8. In initial treatment, fenestration was 12 cases, primary closure using various techniques was 8 cases, and completion pneumonectomy was a case. Massive hemoptysis causing death owing to bronchial pulmonary artery fistula (BPAF) was in 3 cases. Primary closure using various techniques succeeded in 3 cases, while the repair failed in the other 5 case and 2 cases subsequently developed further fatal complications. The mortality rate of primary closure was 25% (2/8) and success rate was 38% (3/8). The mortality rate of fenestration was 8.3% (1/12), and success rate was 91.6% (11/12). The overall mortality rate for postoperative BPF was 25% (6/24); 3 cases were BPAF, 3 cases were aspiration pneumonia.

    Conclusion
    BPF remains a major complication in the surgery of lung cancer because of its high mortality and morbidity rate. Especially, the mortality rate of primary closure using various techniques was high, and aspiration pneumonia with consequent ARDS is fatal complication. To avoid death related to BPF, the surgeons should consider the fenestration as soon as the BPF was diagnosed.