Bronchopleural Fistula and Empyema After Anatomic Lung Resection

Objective Enhanced recovery pathways reduce length of stay and costs following lung resection. However, many fear that early discharge may lead to increased hospital readmissions. In this study, we aimed to determine whether early discharge was associated with increased readmission following anatomic lung resection. Methods Using the lung resection database approved by our institutional review board, we identified all patients undergoing minimally invasive lobectomy and segmentectomy between January 2010 and March 2017 at our institution, where an enhanced recovery pathway is well established. Thirty-day readmissions were compared between patients with short- and average length of stay, defined as 1 to 2 days and 3 to 5 days, respectively. Multivariable logistic regression analysis of patients matched by propensity scores was performed to determine odds of 30-day readmission for each group. Significance was set at P < 0.05. Results A total of 296 patients met inclusion criteria. Unadjusted analysis revealed a 3-fold increased rate of readmission in the group with average length of stay (9%, n = 12) versus the group with short length of stay (3%, n = 5; P < 0.01). At baseline, patients with average length of stay had increased rates of preoperative chemotherapy (13%, n = 18 vs. 4%, n = 6; P < 0.01) and radiation (12%, n = 16 vs. 3%, n = 5). Patients with average length of stay also had higher rates of lobectomy (95%, n = 127 vs. 86%, n = 140; P = 0.02) and postoperative complications (31%, n = 41 vs. 4%, n = 7; P < 0.01). On multivariable analysis, patients with average length of stay had a 2.3-fold greater odds of readmission, which was not statistically significant (OR = 2.33; 95% CI, 0.60 to 9.02; P = 0.22). Conclusions Early discharge following minimally invasive anatomic lung resection does not increase the risk of hospital readmission in patients treated within an enhanced recovery pathway.

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Management and Surgical Outcomes of Concurrent Tuberculosis and Lung Cancer

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1583167 ◽

2016 ◽

Vol 65 (07) ◽

pp. 542-545 ◽

Cited By ~ 3

Author(s):

Volkan Baysungur ◽

Levent Alpay ◽

Bahadir Uskul ◽

Aysun Misirlioglu ◽

Serda Kanbur ◽

...

Keyword(s):

Lung Cancer ◽

Developing Countries ◽

Cell Carcinoma ◽

Lung Resection ◽

Bronchopleural Fistula ◽

Postoperative Mortality ◽

Postoperative Treatment ◽

Common Disease ◽

Pulmonary Tb ◽

Tb Treatment

Background Concurrent pulmonary tuberculosis (TB) and lung cancer are rarely encountered in Western countries; however, it is more common in developing countries. We aim to share the diagnostic and treatment approaches in this study. Materials and Methods Clinical files of all patients undergoing lung resection for non–small cell carcinoma with concurrent pulmonary TB between February 2006 and December 2012 were investigated retrospectively in terms of patient characteristics, operation methods, definite pathology and stage of tumor, postoperative treatment schemes, and associated complications. Results TB was detected in 17 (1.3%) of 1,266 operated carcinoma patients. Eleven had squamous cell carcinoma and six had adenocarcinoma. Mean age was 54.9 years. Two patients received anti-TB treatment preoperatively. Fifteen patients were given anti-TB treatment postoperatively, as soon as definite microbiological confirmation was obtained, and concurrently given adjuvant therapy after 3 weeks of sole four-drug TB treatment. Pneumonectomy was performed in four (23.5%), sleeve lobectomy in three (17.6%), lobectomy in eight (47%), and bilobectomy in two (11.7%) patients. Postoperative complications occurred in four (23.5%) patients, with bronchopleural fistula being seen in only one pneumonectomy patient. No postoperative mortality or reactivation of TB was seen. Mean survival time was 32 ± 2 months. Conclusion Resection following a 3-week anti-TB treatment or concurrent anti-TB and postoperative adjuvant chemotherapy does not constitute an additional postoperative risk for patients with concomitant lung malignancy and pulmonary TB. The determination of optimum treatment for these patients presents a challenge in developing countries, where TB is still a common disease.

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Factors Associated with Successful Postoperative Day One Discharge Following Anatomic Lung Resection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2020.07.059 ◽

2020 ◽

Author(s):

Christopher W. Towe ◽

Dylan P. Thibault ◽

Stephanie G. Worrell ◽

Katelynn C. Bachman ◽

Yaron Perry ◽

...

Keyword(s):

Lung Resection ◽

Factors Associated ◽

Anatomic Lung Resection

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Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula?

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01290-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Fatmir Caushi ◽

Gentiana Qirjako ◽

Ilir Skenduli ◽

Daniela Xhemalaj ◽

Hasan Hafizi ◽

...

Keyword(s):

Lung Cancer ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Lung Resection ◽

Bronchopleural Fistula ◽

Neoadjuvant Treatment ◽

Bronchial Stump ◽

Study Results

Abstract Background/aim The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.

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