POSTOPERATIVE COMPLICATIONS AFTER BRONCHOPLASTIC PROCEDURES IN THE TREATMENT OF BRONCHIAL MALIGNANCIES

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.