M. Kruger et al., POSTOPERATIVE COMPLICATIONS AFTER BRONCHOPLASTIC PROCEDURES IN THE TREATMENT OF BRONCHIAL MALIGNANCIES, European journal of cardio-thoracic surgery, 14(1), 1998, pp. 46-52
Objective: The purpose of this study was to determine the frequency of
postoperative complications after bronchoplastic procedures in the tr
eatment of pulmonary malignant tumors and to analyze the factors influ
encing the complication rate. Methods: During a 5-year-period (1992-19
96) 79 patients (68 male, 11 female, mean age 57 years) underwent reco
nstructive operations for bronchial malignancies. We performed 58 bron
choplastic procedures and 21 combined broncho- and angioplastic proced
ures. Among the bronchoplastic procedures the number of sleeve resecti
ons (n = 44) and wedge resections (n = 35) were comparable. Results: F
ifty-nine patients (74.7%) showed a regular postoperative course; 12 p
atients (15.2%) had severe postoperative complications (death, re-oper
ation). Concerning the primary operation the operative 30-day mortalit
y was 5.1% (n = 4) and including the two deaths after re-operation it
was 7.6% (n = 6). After subdividing the patients into three groups (se
vere, less severe and no complications) we tried to determine predicto
rs for occurrence of postoperative complications. There was a higher r
ate of severe complications in the age group 61-70 years (6/25 = 24%)
as compared with younger patients between 51 and 60 years (4/38 = 10.5
%; P < 0.05). Concerning the location, the outcome was better after sl
eeve- or wedge lobectomies of the upper lobes (four complications/51 p
atients = 7.8%) compared with procedures of the lower lobes (3/ 14 = 2
1.4%). The data could not prove a lower frequency of severe postoperat
ive complications or specific morbidity after pleural coverage followi
ng bronchial sleeve resection. The complication rate was higher when s
leeve resection of the bronchus was performed (10/ 44 = 22.7%) as comp
ared with wedge resections (2/35 = 5.7%; P = 0.011) and after resectio
n of T3/T4 tumors (6/28 = 21.4%) compared with T1/T2 tumors (4/37 = 10
.8%; P < 0.05). Conclusions: Bronchoplastic procedures represent a fai
rly safe therapy opportunity in patients with centrally localized bron
chial carcinoma and compromised or uncompromized pulmonary function. I
n this study the complication rate was higher after sleeve resection o
f the bronchus as compared with wedge resection. Pleural coverage of t
he anastomosis was not effective to prevent major complications due to
dehiscence of the bronchial anastomosis. A pedicled muscle flap could
be a valuable alternative. (C) 1998 Elsevier Science B.V. All rights
reserved.