Abstract
We studied a series of patients with primary lung cancer whc underwent bronchofiberscopy (BF) to treat bronchial secretion retention after pulmonary resection. Our primary aim was to determine clinical characteristics useful in predicting a favorable outcome. Between January 1991 and December 1998, 199 patients with primary lung cancer were surgically treated at Showa University Hospital. Twenty-four of these patients required postoperative BF therapy. Sixty-seven BF procedures, including bronchial suction and irrigation with saline solution, were performed. Among the 24 patients who underwent pneumonectomy, 4 received 14 BF treatments. Of the 161 patients who underwent lobectomy, 20 received 53 BF treatments. None of the 14 patients who underwent partial lung resection required BF. Three of the 4 patients who received BF treatment after pneumonectomy had acute respiratory distress syndrome (ARDS) . The development of irregular bronchial branching after upper lobectomy was associated with retention of bronchial secretion. Patients with prolonged postoperative air leakage, or severe bronchial ischemia due to extended mediastinal and hilar node dissection, required repeated BF. Surgical technique improved with experience, and BF treatment for prolonged air leakage, the main reason for BF in the first 4 years of the study, did not occur during the following 4 years. However, in the latter part of this study, more patients developed severe bronchial ischemia due to extended lymph node dissection or poor preoperative respiratory function, and as a result required BF therapy. Overall, the number of BF procedures performed during the 8 years of the study remained stable. We conclude that patients who have poor preoperative respiratory function, severe bronchial ischemia, prolonged air leakage, or ARDS should undergc early BF treatment. Treatment should be performed when chest ausculation suggests retention of bronchial secretions, before the development of radio. graphic abnormalities, to avoid potentially fatal complications, such as obstructive pneumonia.
