Prevention of postpneumonectomy bronchial fistulas in thoracic oncosurgery

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.4.262254

Keywords:

bronchial fistula, lymphadenectomy, pneumonectomy, postoperative complications, lung cancer, diaphragm plasty

Abstract

Pneumonectomy is a widely used surgical intervention in thoracic oncosurgery. One of the most severe complications of this operation is postpneumonectomy bronchial fistula (PBF), and the incidence of PBF after “right-sided” operations is 2.5–5.0 times higher than after “left-sided” ones. There is no single approach to the prevention of this complication. It is obvious that it is necessary to find the most effective methods of PBF prevention in thoracic oncosurgery, especially after “right-sided” operations.

Aim. To study the efficiency of diaphragmoplasty of the right main bronchial stump after pneumonectomy performed with lymphadenectomy for malignant neoplasms of the lung.

Materials and methods. A retrospective analysis of the treatment including 38 patients operated on in the volume of right-sided pneumonectomy with lymphadenectomy up to D2–D3a from 2014 to 2021 was carried out. Patients were divided into 2 groups: group 1 – patients for whom the stump of the right main bronchus was closed by the Sweet techniques using mechanical suturing devices followed by a reinforcing layer of interrupted Vicryl sutures (n = 28); group 2 – patients who underwent diaphragmoplasty for the stump of the right main bronchus according to D. A. Chichevatov with our modification (n = 10) after suturing by the same techniques.

Results. In group 1, PBF occurred in 25 %, the rate of PBS was 0 % in group 2.

Conclusions. Diaphragmoplasty for the stump of the right main bronchus according to D. A. Chichevatov with our modification after pneumonectomy performed with lymphadenectomy up to D2–D3a reduced the incidence of PBS by 25 %.

 

Author Biographies

V. V. Hrubnyk, Odesa National Medical University, Odesa Regional Clinical Hospital, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Surgery No. 1 with Postgraduate Training

M. Ye. Dushko, Odesa Regional Clinical Oncological Dispensary, Ukraine

MD, Extramural Postgraduate student of the Department of Surgery No. 1 with Postgraduate Training, Odesa National Medical University, thoracic surgeon, oncosurgeon of the highest category

References

Andreetti, C., Menna, C., D'Andrilli, A., Ibrahim, M., Maurizi, G., Poggi, C., Rendina, E. A., Venuta, F., Santini, M., & Fiorelli, A. (2018). Multimodal Treatment for Post-Pneumonectomy Bronchopleural Fistula Associated With Empyema. The Annals of thoracic surgery, 106(6), e337-e339. https://doi.org/10.1016/j.athoracsur.2018.05.094

Gursoy, S., Yazgan, S., Ucvet, A., Samancilar, O., Unal, M., Gulmez, B., & Sirzai, E. Y. (2018). Postpneumonectomy bronchopleural fistula in non-small cell lung cancer patients: incidence, survival, mortality, and treatment analysis. Surgery today, 48(7), 695-702. https://doi.org/10.1007/s00595-018-1648-5

Hicham, H., Ibrahim, I., Rabiou, S., Marouane, L., Yassine, O., & Mohamed, S. (2020). Postpneumonectomy empyema: risk factors, prevention, diagnosis, and management. Asian cardiovascular & thoracic annals, 28(2), 89-96. https://doi.org/10.1177/0218492319888048

Mammana, M., Marulli, G., Zuin, A., Perissinotto, E., Comacchio, G. M., De Franceschi, E., & Rea, F. (2020). Postpneumonectomy bronchopleural fistula: analysis of risk factors and the role of bronchial stump coverage. Surgery today, 50(2), 114-122. https://doi.org/10.1007/s00595-019-01871-0

Mazzella, A., Pardolesi, A., Maisonneuve, P., Petrella, F., Galetta, D., Gasparri, R., & Spaggiari, L. (2018). Bronchopleural Fistula After Pneumonectomy: Risk Factors and Management, Focusing on Open-Window Thoracostomy. Seminars in thoracic and cardiovascular surgery, 30(1), 104-113. https://doi.org/10.1053/j.semtcvs.2017.10.003

Nachira, D., Chiappetta, M., Fuso, L., Varone, F., Leli, I., Congedo, M. T., Margaritora, S., & Granone, P. (2018). Analysis of risk factors in the development of bronchopleural fistula after major anatomic lung resection: experience of a single centre. ANZ journal of surgery, 88(4), 322-326. https://doi.org/10.1111/ans.13886

Okuda, M., Go, T., & Yokomise, H. (2017). Risk factor of bronchopleural fistula after general thoracic surgery: review article. General thoracic and cardiovascular surgery, 65(12), 679-685. https://doi.org/10.1007/s11748-017-0846-1

Teh, E., & West, D. (2017). Bronchopleural fistula: Prevention is still best. Shanghai Chest, 1(6). https://doi.org/10.21037/shc.2017.10.05

Grubnik, V. V., & Dushko, N. E. (2020). Kombinirovannyi metod lecheniya postpnevmonektomicheskikh bronkhial'nykh svishchei: novoe zvuchanie staroi problem [Combined method of treatment of post-pneumoectomy bronchial fistula treatment: a new sound of the old problem]. Klinichna onkolohiia, 10(1-2), 26-33. [in Russian]. https://doi.org/10.32471/clinicaloncology.2663-466X.37-1.26901

Bribriesco, A., & Patterson, G. A. (2018). Management of Postpneumonectomy Bronchopleural Fistula: From Thoracoplasty to Transsternal Closure. Thoracic surgery clinics, 28(3), 323-335. https://doi.org/10.1016/j.thorsurg.2018.05.008

Chittithavorn, V., Duangpakdee, P., Rergkliang, C., & Preukprasert, N. (2018). A novel approach for the treatment of post-pneumonectomy bronchopleural fistula by using an autologous corticocancellous bone graft. Journal of thoracic disease, 10(7), 4453-4463. https://doi.org/10.21037/jtd.2018.07.01

Petrella, F., Sandri, A., Rizzo, S., Borri, A., Galetta, D., Gasparri, R., & Spaggiari, L. (2018). Emergency drain for post pneumonectomy bronchopleural fistula: a drain placement technique based on the siphon principle. Journal of thoracic disease, 10(1), 468-471. https://doi.org/10.21037/jtd.2017.11.145

Stern, J. B., Fournel, L., Wyplosz, B., Girard, P., Al Nakib, M., Gossot, D., & Seguin-Givelet, A. (2018). Early and delayed post-pneumonectomy empyemas: Microbiology, management and prognosis. The clinical respiratory journal, 12(4), 1753-1761. https://doi.org/10.1111/crj.12740

Wang, Y. Q., Juma, A. N., Chen, Y., Zhou, Y., Xia, K., Peng, X., & Zhuang, W. (2018). The incidence and management of bronchopleural fistula after major lung resection. Chirurgia, 31(2), 45-51. https://doi.org/10.23736/S0394-9508.17.04696-4

Caushi, F., Qirjako, G., Skenduli, I., Xhemalaj, D., Hafizi, H., Bala, S., Hatibi, A., & Mezini, A. (2020). Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula?. Journal of cardiothoracic surgery, 15(1), 248. https://doi.org/10.1186/s13019-020-01290-0

Downloads

Published

2022-09-06

How to Cite

1.
Hrubnyk VV, Dushko MY. Prevention of postpneumonectomy bronchial fistulas in thoracic oncosurgery. Zaporozhye medical journal [Internet]. 2022Sep.6 [cited 2024Apr.26];24(4):415-9. Available from: http://zmj.zsmu.edu.ua/article/view/262254

Issue

Vol. 24 No. 4 (2022)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)