PURPOSE: Assessment of anastomosis after sleeve resection relies on bronchoscopic/radiographic evaluation. Up to 25% of patients show impaired healing and 4-9% develop complete dehiscence. Decision to reoperate may be delayed, as endoscopic differentiation of superficial necrosis from deep destruction can be difficult. Since endobronchial ultrasound (EBUS) allows visualization of the 7 layers of the bronchial wall and its surroundings, we investigated EBUS in evaluation of anastomoses after sleeve resection for lung tumors.
METHODS: Anastomoses of 128 patients undergoing sleeve resection in 2 years (2008-09) were evaluated by bronchoscopy and EBUS on day 7, and in impaired healing again on day 12 and following. EBUS images by a 20MHz-radial probe with balloon at the site of anastomosis were interpreted for presence of edema, necrosis, dehiscence, surrounding fluid, vessels in the vicinity and position of covering flap. According to the findings, the healing process was classified as uncomplicated, delayed and insufficient.
RESULTS: Uncomplicated anastomoses showed normal layers; delayed healing showed mucosal edema and loss of layer structure; insufficient healing revealed defects of the wall, surrounding fluid collection, detachment of flap and lack of distance to vessels. Healing in 123(96,1%) patients was uncomplicated, in 2(1,6%) was delayed, some requiring broncoscopic intervention (dilation, stent). In 3(2,3%) it was insufficient, all requiring reoperation. Surgery confimed EBUS findings.
CONCLUSION: Our study showed that EBUS after sleeve resections adds to bronchoscopic findings and was useful in decision for reoperation of patients with insufficient healing.
CLINICAL IMPLICATIONS: EBUS might be a useful tool for decision making in complicated healing of anastomoses after sleeve resection.
DISCLOSURE: Heinrich Becker, No Financial Disclosure Information; No Product/Research Disclosure Information