Peng Zhiyu, Mei Jiandong, Liu Chengwu, Guo Chenglin, Gonzalez Michel, Bölükbas Servet, Voltolini Luca, Pu Qiang, Liu Lunxu
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China.
Transl Lung Cancer Res. 2022 May;11(5):744-756. doi: 10.21037/tlcr-22-272.
Bronchopleural fistula (BPF) is a rare but severe complication following bronchoplasty. Identification of the risk factors for the development of BPF after bronchoplasty may contribute to better perioperative management, thereby further improving the prognosis of these patients. However, few studies have focused on the risk factors for BPF after bronchoplasty. This study aimed to explore the risk factors and outcomes for BPF after bronchoplasty in patients with non-small cell lung cancer (NSCLC).
The data of NSCLC patients who underwent bronchoplasty between September 2005 and August 2020 in our institution were retrospectively reviewed. Detailed information on demographic characteristics, preoperative assessment, perioperative outcomes were collected from Western China Lung Cancer Database. The diagnosis of BPF was confirmed by bronchoscopy. Risk factors for BPF were assessed by univariate and multivariate logistic regression analysis.
A total of 503 patients were included in this study, including 132 (26.2%) cases of broncho-vascular plasty, 340 (67.6%) cases of bronchial sleeve lobectomy, and 31 (6.2%) cases of bronchial wedge plasty. Among these patients, 16 (3.2%) developed postoperative BPF. Six patients with BPF died during hospital-stay, including two cases of severe hemoptysis, and four cases of pyothorax and respiratory failure caused by BPF. One of the other ten patients underwent reoperation. After univariate and multivariate logistic regression analysis, preoperative Charlson Comorbidity Index (CCI) ≥2 [odds ratio (OR) =5.120, 95% confidence interval (CI): 1.193-21.985, P=0.028], right middle and/or lower lobectomy (OR =4.840, 95% CI: 1.133-20.686, P=0.033), and residual tumor in the bronchial margin (OR =4.160, 95% CI: 1.106-15.644, P=0.035) were identified as independent risk factors for postoperative BPF.
Although complication rate of BPF after bronchoplasty is low, the mortality of BPF is high. Patients with higher CCI, those who undergo right middle and/or lower lobectomy, and those with residual tumor in the bronchial margin are at increased risk of BPF. This study highlights the importance of preoperative evaluation and good intraoperative management to prevent this catastrophic complication.
支气管胸膜瘘（BPF）是支气管成形术后一种罕见但严重的并发症。明确支气管成形术后BPF发生的危险因素可能有助于更好地进行围手术期管理，从而进一步改善这些患者的预后。然而，很少有研究关注支气管成形术后BPF的危险因素。本研究旨在探讨非小细胞肺癌（NSCLC）患者支气管成形术后BPF的危险因素及预后情况。
回顾性分析2005年9月至2020年8月在我院接受支气管成形术的NSCLC患者的数据。从中国西部肺癌数据库收集患者人口统计学特征、术前评估、围手术期结局的详细信息。BPF的诊断通过支气管镜检查确诊。通过单因素和多因素logistic回归分析评估BPF的危险因素。
本研究共纳入503例患者，其中包括132例（26.2%）支气管血管成形术、340例（67.6%）支气管袖状肺叶切除术和31例（6.2%）支气管楔形成形术。在这些患者中，16例（3.2%）发生了术后BPF。6例BPF患者在住院期间死亡，其中2例死于严重咯血，4例死于BPF引起的脓胸和呼吸衰竭。另外10例患者中有1例接受了再次手术。经过单因素和多因素logistic回归分析，术前Charlson合并症指数（CCI）≥2[比值比（OR）=5.120，95%置信区间（CI）：1.193 - 21.985，P = 0.028]、右中肺和/或下肺叶切除术（OR = 4.840，95% CI：1.133 - 20.686，P = 0.033）以及支气管切缘残留肿瘤（OR = 4.160，95% CI：1.106 - 15.644，P = 0.035）被确定为术后BPF的独立危险因素。
尽管支气管成形术后BPF的并发症发生率较低，但BPF的死亡率较高。CCI较高的患者、接受右中肺和/或下肺叶切除术的患者以及支气管切缘残留肿瘤的患者发生BPF的风险增加。本研究强调了术前评估和良好的术中管理对预防这种灾难性并发症的重要性。
