Virtual Library
Start Your Search
K. Abe
Author of
-
+
P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P3.02-009 - Predictors of Prolonged Air Leak after Pulmonary Lobectomy (ID 756)
09:30 - 09:30 | Author(s): K. Abe
- Abstract
Background:
Prolonged air leak (PAL) is a common complication, which occurs in 3% to 25% of patients undergoing pulmonary resection. PAL may cause severe morbidity such as pneumonia and empyema, and prolong the need for chest tube drainage and hospitalization. Thus, a careful perioperative management to decrease the risk of PAL is needed. The purpose of this study is to analyze the significance of various risk factors for postoperative PAL (air leak longer lasting more than 7 days) in patients undergoing pulmonary lobectomy for lung cancer.
Methods:
This study includes 134 patients who underwent pulmonary lobectomy for lung cancer between September 2009 and December 2014 at Kyoto Prefectural University of Medicine. We usually approached through video assisted thoracoscopic surgery that used a mini-thoracotomy and two ports. The divided interlober fissures and the small pleural defects causing minor air leak were covered with bioabsorbable sheet and/or fibrin glue. The patients with pulmonary air leak lasting until postoperative day 7 underwent pleurodesis. We retrospectively analyzed the perioperative variables in the two groups of the patients with PAL or without PAL. All results were expressed as mean ± standard error (patients with PAL vs patients without PAL). P-value <0.05 was considered statistically significant.
Results:
PAL occurred in 17 patients (12.7%), lasting an average of 8.9 days. The patients were 16 men and 1 woman with a mean age of 70.3 years old (58-79 years old). All patients underwent pleurodesis with successful closure of air leak and no patients required re-thoracotomy. Univariate analysis demonstrated significant independent predictors of PAL; a male predominance (94 vs 57% ;p=0.004), a high Brinkman index (960±580 vs 490±590; p=0.003), a preoperative low serum albumin level (4.0±0.7 vs 4.3±0.3 g/dl; p=0.003), and a long operative time (230±84 vs 184±53 min; p=0.045). A tendency toward a longer stapler length used for the interlober fissure division was also shown in the patient with PAL (109±61 vs 77±68 mm; p=0.064). PAL was not influenced by age, BMI, preoperative serum total protein level, preoperative hemoglobin, preoperative total lymphocyte count, %VC, FEV1.0%, resected lobe, and pleural adhesions.
Conclusion:
We report that a male, a long smoking history, a preoperative low albumin level, and a long operative time increased the risk of air leak lasting more than 7 days following lobectomy for primary lung cancer. Pleural adhesion, which had been reported to be a risk factor of PAL, was not related with PAL. Our analysis suggests that, for the sake of preventing PAL, we should pay attention to the preoperative nutritional status as well as well as surgical techniques, such as interlober fissure division in the cases that need multiple stapling to complete fissures.
