Early Detection of Occult Bronchopleural Fistula After Routine Standard Pneumonectomy

Abstract

Objective: The aim of this study was to define symptoms and signs for early diagnosis of occult bronchopleural fistula (OBPF) after routine pneumonectomy. Patients and Method: From 1999 to 2003, 301 pneumonectomies for malignancy were performed. The records of these patients were retrospectively analyzed for several clinicopathologic factors. All patients (group A) that presented postoperatively with one or more suspicious symptoms and signs were recorded. These cases were grouped according to bronchopleural fistula documentation (group A1) or not (group A2). Both groups were subjected to multivariate analysis. Results: In 10 cases (3.3 %) bronchopleural communication was confirmed (group A1). The most frequent signs included the lack of contracture or even enlargement of postpneumonectomy space (52.7 %), subcutaneous emphysema (33.3 %), fever (27.7 %), respiratory insufficiency (27.7 %), and cough (22.2 %). Multivariate analysis disclosed failure of the postpneumonectomy space to contract as an independent prodromal sign for bronchopleural communication (p = 0.03, odds ratio 58.3, 95 % CI: 1.45 - 2335.9). Conclusion: Chest radiology proved to be the diagnostic modality of choice for early detection of bronchopleural fistula.

Key words

Bronchopleural fistula - pneumonectomy - microfistula

References

• 1 Klepetko W, Taghavi S, Perezslenyi A. et al . Impact of different coverage techniques on incidence of postpneumonectomy stump fistula.  Eur J Cardiothro Surg. 1999;  15 758-763
• 2 Deschamps C, Bernard A, Nichols III F C. et al . Empyema and bronchopleural fistula after pneumonectomy: factors affecting incidence.  Ann Thorac Surg. 2001;  72 243-248
• 3 Wright C D, Wain J C, Mathisen D J. et al . Postpneumonectomy bronchopleural fistula after sutured bronchial closure: incidence, risks factors, and management.  J Thorac Cardiovasc Surg. 1996;  112 1367-1371
• 4 Hollaus P H, Lax F, El-Nashef B B. et al . Natural history of bronchopleural fistula after pneumonectomy: a review of 96 cases.  Ann Thorac Surg. 1997;  63 1391-1397
• 5 Asamura H, Naruke T, Tsuchiya R. et al . Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management and outcome.  J Thorac Cardiovasc Surg. 1992;  104 1456-1464
• 6 Gall S A, Wolfe W G. Management of microfistula following pulmonary resection.  Chest Surg Clin North Am. 1996;  3 543-564
• 7 O'Meara J B, Slade P R. Disappearance of fluid from the postpneumonectomy space.  J Thorac Cardiovasc Surg. 1974;  67 621-628
• 8 Ferguson M K. Assessment of operative risk for pneumonectomy.  Chest Surg Clin North Am. 1999;  9 339-351
• 9 Al-Kattan K, Cattalani L, Goldstraw P. Bronchopleural fistula after pneumonectomy with a hand suture technique.  Ann Thorac Surg. 1994;  58 1433-1436
• 10 Hubaut J J, Baron O, Al Habash O. et al . Closure of the bronchial stump by manual suture and incidence of bronchopleural fistula in a series of 209 pneumonectomies for lung cancer.  Eur J Cardiothorac Surg. 1999;  16 418-423
• 11 Sugarbaker D J, Herndon J, Kohman L J. The Cancer and Leukemia Group B Thoracic Surgery Group . Results of Cancer and Leukemia Group B protocol 8935: a multi-institutional phase II trimodality trial for stage IIIA (N2) non-small-cell lung cancer.  J Thorac Cardiovasc Surg. 1995;  109 473-485
• 12 Regnard J F, Icard P, Magdeleinat P. et al . Completion pneumonectomy: experience in eighty patients.  J Thorac Cardiovasc Surg. 1999;  117 1095-1101
• 13 Algar F J, Alvarez A, Aranda J L. et al . Prediction of early bronchopleural fistula after pneumonectomy: a multivariate analysis.  Ann Thorac Surg. 2001;  72 1662-1667
• 14 Darling G E, Abdurahman A, Yi Q L. et al . Risk of right pneumonectomy: role of bronchopleural fistula.  Ann Thorac Surg. 2005;  79 433-437
• 15 Massard G, Dabbagh A, Wihlm J M. et al .Pneumonectomy for chronic infection is a high-risk procedure. 1996 62: 1033-1037
• 16 Madden B P, Sheth A, Ho T B, McAnulty G R, Sayer R E. A novel approach to the management of persistent postpneumonectomy bronchopleural fistula.  Ann Thorac Surg. 2005;  79 2128-2130
• 17 Athanassiadi K, Vassilikos K, Misthos P. et al . Late postpneumonectomy fistula.  Thorac Cardiovasc Surg. 2004;  52 298-301
• 18 Franz B J, Murphy J D. The masked bronchopleural fistula.  J Thorac Surg. 1955;  29 512-517