Abstract
We analyzed patient profiles and therapeutic outcomes in 9 cases of postoperative bronchopleural fistula encountered in our hospital between January 1995 and December 2007. The mean patient age was 67.4 years (range, 58-73 years). All patients were male. Primary diseases on initial operations were pulmonary cicatrization in 1 patient and primary lung cancer in 8. The incidence of postoperative bronchopleural fistula among primary lung cancer patients was 1.3% for all anatomical pulmonary resections, 7.7% for left pneumonectomy, and 6.1% for right lower lobectomy. Right lower lobectomy showed a significantly higher risk compared with other lobectomies (p<0.001). Especially in right lower lobectomy, cutting of the right bronchial artery was suggested to be one of the causes of bronchopleural fistula. Postoperative bronchopleural fistulas occurred after 2-3 weeks in 7 of the 9 patients, and after one month in the other 2. The fistula was successfully treated by bronchofiberscopic occlusion in 1 patient. While the first re-operation combined with pedicled omentopexy was successful in 4 patients, the remaining 4 patients unsuccessfully underwent only primary closure of the bronchofistula or additional lobectomy. Three of these 4 patients finally achieved successful closure on the second re-operation with pedicled omentopexy. One patient finally showed failed closure of the fistula. Four patients developed postoperative MRSA pneumonia, with 3 of these patients dying of subsequent ARDS. One patient recovered from MRSA pneumonia and was discharged. The mortality rate was 33.3% for all cases and 37.5% for the 8 re-operated cases. Re-operation should be performed in the early stage of postoperative bronchopleural fistula, before pyothorax becomes advanced. Pedicled omentopexy is a useful procedure and should be applied in the first re-operation, if available. Postoperative pneumonia is a fatal complication of this condition and must be managed as a priority.
