[Risk factors for bronchopleural complications after pneumonectomy].

Abstract

Objective: To assess various risk factors for bronchopleural complications, as well as effectiveness of some techniques for bronchial stump closure and covering.

Material and methods: We studied the results of 2022 pneumonectomies between 1958 and 2023. Different techniques for bronchial stump closure and covering were used. We studied the influence of the following factors on the incidence of bronchial fistula: pulmonary disease; pulmonary lesion complicated by bleeding, empyema; acute progression of tuberculosis as caseous pneumonia; Mycobacterium tuberculosis with multiple and extensive drug resistance; tuberculosis of the main bronchus; preoperative destructive tuberculosis-related lesion of contralateral lung; pulmonary gangrene; partial resection of cancer; extended bilateral lymph node dissection, etc.

Results: The incidence of bronchopleural complications and mortality significantly decreased over time. Nevertheless, these events remained the main cause of death after pneumonectomy until the last decade. Most often, death following bronchopleural complications was noted in patients with bronchial fistula within 21 days. Among 111 patients with this complication, 48 (43.24%) ones died.

Conclusion: According to our data, bronchial suturing technique and side of surgery are the most significant factors regarding the incidence of bronchial fistula. The highest risk is associated with surgery for pulmonary gangrene, the lowest risk - with total resection of cancer. The incidence of delayed bronchial fistula in tuberculosis exceeds the incidence of early bronchial fistula.