Background. Bronchopleural fistulas are a major therapeutic challenge. We have reviewed our experience to establish the best choice of treatment. Methods. From January 2001 to December 2013, the records of 3,832 patients who underwent pulmonary anatomic resections were retrospectively reviewed. Results. The overall incidence of bronchopleural fistulas was 1.4% (52 of 3,832): 1.2% after lobectomy and 4.4% after pneumonectomy. Pneumonectomy vs lobectomy, right-sided vs left-sided resection, and hand-sewn closure of the stump vs stapling showed a statistically significant correlation with fistula formation. Primary bronchoscopic treatment was performed in 35 of 52 patients (67.3%) with a fistula of less than 1 cm and with a viable stump. The remaining 17 patients (32.7%) underwent primary operation. The fistula was cured with endoscopic treatment in 80% and with operative repair in 88.2%. Cure rates were 62.5% after pneumonectomy and 86.4% after lobectomy. The cure rate with endoscopic treatment was 92.3% in very small fistulas, 71.4% in small fistulas, and 80% in intermediate fistulas. The cure rate after surgical treatment was 100% in small fistulas, 75% in intermediate fistulas, and 100% in very large fistulas. Morbidity and mortality rates were 5.8% and 3.8%, respectively. Conclusions. The bronchoscopic approach shows very promising results in all but the largest bronchopleural fistulas. Very small, small, and intermediate fistulas with a viable bronchial stump can be managed endoscopically, using mechanical abrasion, polidocanol sclerosing agent, and cyanoacrylate glue. Bronchoscopic treatment can be repeated, and if it fails, does not preclude subsequent successful surgical treatment.

The Rationale for Treatment of Postresectional Bronchopleural Fistula: Analysis of 52 Patients / G., Cardillo; L., Carbone; F., Carleo; G., Galluccio; M., Di Martino; R., Giunti; G., Lucantoni; P., Battistoni; S., Batzella; R., Dello Iaono; Petrella, Lea; M., Dusmet. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - STAMPA. - 100:(2015), pp. 251-257. [10.1016/j.athoracsur.2015.03.014]

The Rationale for Treatment of Postresectional Bronchopleural Fistula: Analysis of 52 Patients

PETRELLA, Lea;
2015

Abstract

Background. Bronchopleural fistulas are a major therapeutic challenge. We have reviewed our experience to establish the best choice of treatment. Methods. From January 2001 to December 2013, the records of 3,832 patients who underwent pulmonary anatomic resections were retrospectively reviewed. Results. The overall incidence of bronchopleural fistulas was 1.4% (52 of 3,832): 1.2% after lobectomy and 4.4% after pneumonectomy. Pneumonectomy vs lobectomy, right-sided vs left-sided resection, and hand-sewn closure of the stump vs stapling showed a statistically significant correlation with fistula formation. Primary bronchoscopic treatment was performed in 35 of 52 patients (67.3%) with a fistula of less than 1 cm and with a viable stump. The remaining 17 patients (32.7%) underwent primary operation. The fistula was cured with endoscopic treatment in 80% and with operative repair in 88.2%. Cure rates were 62.5% after pneumonectomy and 86.4% after lobectomy. The cure rate with endoscopic treatment was 92.3% in very small fistulas, 71.4% in small fistulas, and 80% in intermediate fistulas. The cure rate after surgical treatment was 100% in small fistulas, 75% in intermediate fistulas, and 100% in very large fistulas. Morbidity and mortality rates were 5.8% and 3.8%, respectively. Conclusions. The bronchoscopic approach shows very promising results in all but the largest bronchopleural fistulas. Very small, small, and intermediate fistulas with a viable bronchial stump can be managed endoscopically, using mechanical abrasion, polidocanol sclerosing agent, and cyanoacrylate glue. Bronchoscopic treatment can be repeated, and if it fails, does not preclude subsequent successful surgical treatment.
2015
Bronchoscopi treatment ; bronchopleural fistulas
01 Pubblicazione su rivista::01a Articolo in rivista
The Rationale for Treatment of Postresectional Bronchopleural Fistula: Analysis of 52 Patients / G., Cardillo; L., Carbone; F., Carleo; G., Galluccio; M., Di Martino; R., Giunti; G., Lucantoni; P., Battistoni; S., Batzella; R., Dello Iaono; Petrella, Lea; M., Dusmet. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - STAMPA. - 100:(2015), pp. 251-257. [10.1016/j.athoracsur.2015.03.014]
File allegati a questo prodotto
File Dimensione Formato  
Petrella_Rationale-Treatment -Postresectional_2015.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 125.93 kB
Formato Adobe PDF
125.93 kB Adobe PDF   Contatta l'autore

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/778329
Citazioni
  • ???jsp.display-item.citation.pmc??? 15
  • Scopus 54
  • ???jsp.display-item.citation.isi??? 48
social impact