96P - The role of bronchial stump reinforcement by flap in prevention of broncho-pleural fistula after major lung resections

Early stage NSCLC

96P - The role of bronchial stump reinforcement by flap in prevention of broncho-pleural fistula after major lung resections

Authors

Fatmir Caushi (AL)
Ilir Skenduli (AL)
Arjan Mezini (AL)
Alban Hatibi (AL)
Hasan Hafizi (AL)
Silvana Bala (AL)
Emira Hysa (AL)
Fahri Kokiqi (AL)

Presenter

Fatmir Caushi (AL)

Abstract

Abstract

Background

Lung resection remain the treatment of choice especially for bronchogenic carcinoma and as well as for intractable end stage localized lung disease such as tuberculosis, bronchiectasis, lung abscess and complicated hydatid cyst. The development of bronchopleural fistula (BPF) remain the most devastating complications that may arise after lung resection especially after pneumonectomy. Bronchial stump reinforcement has been shown to significantly reduce incidence of BPF. There have been described various coverage techniques as: intercostal muscle flap, pleural flap, pericardial fat pad, diaphragm and azygous vein. The aim of this study is to compare the efficiency of bronchial stump reinforcement with flap versus non-reinforcement after major lung resection.

Methods

This is a retrospective study where was analised the data for 300 patients who underwent major lung resections. 38 patients underwent pulmonectomy and the rest lobectomy, bilobectomy and sleeve lobectomy. The follow up period varied from 6 months up to 10 years. The patients were divided into 2 groups according to method of bronchial stump reinforcement or not. Two groups were matched as regard to: patient age, sex distribution, lung pathology and risk factors.

Results

78.1% of patients had the diagnosis of NSCLC where 10% of them were subjected to neo-adjuvant chemotherapy. Only in 50% of patients that underwent pulmonectomy, the bronchial stump was reinforced by diverse nature of flap. Meanwhile, according to patients that underwent the other types of lung resections, the bronchial stump was reinforced by flap only in 7% of cases. There was 3% mortality in both groups for a period of postoperative follow up 3 months. Complications were observed in both groups, but BPF happened in 20 patients where only in three of them was performed the bronchial stump reinforcement.

Conclusions

Intercostals muscle flap, pericardial fat pad and pleural flap are valuable and effective methods in prevention of broncho-pleural fistula following lung resection especially in pulmonectomies and broncho-sleeve lung resections. Surgical techniques using flap reinforcement seems to play a major role in the prevention of BPF especially after neo-adjuvant chemotherapy.