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STANDARDIZED BRONCHIAL STUMP PROTECTION AFTER PNEUMONECTOMY FOR NSCLC: A PROSPECTIVE STUDY FREE TO VIEW

Erich Hecker, MD, FCCP*; Katrin Welcker, MD; Friederich Schumm, MD; Bettina Schlolaut, MD
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Klinikum Bremen-Ost, Bremen, Germany



Chest. 2006;130(4_MeetingAbstracts):103S. doi:10.1378/chest.130.4_MeetingAbstracts.103S-b
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Abstract

PURPOSE: Bronchial stump fistula after pneumonectomy (PNE) is the most feared and specific complication characterized by high morbidity and mortality. To reduce this specific risk it is necessary to perform a systematic surgical stump protection beside a diligently bronchial suture.

METHODS: In a prospective clinical trial between 5/03 and 3/06 in all patients who underwent a PNE for NSCLC the bronchial suture was protected with a standardized pedicled pericardial fat flap.

RESULTS: 232 patients were included (178 male, 44 –86 years, 54 female, 44-81 years). 157 right PNE and 75 left side PNE followed. Extended pneumonectomy was necessary in 158 cases [intrapericardial vascular resection (n= 99), partial resection of the atrium (n= 51), partial resection of the esophagus (n=8)]. The postoperative tumour stage was Ib (n=2), IIa(n=14), IIb (n=27) IIIa (n=148), IIIb (n=36) and stage IV (n=5). Histological R-1 resection were found in 6 cases (mediastinal fat (n=3), atrium n=2), A. pulmomalis (n=1).No evidence of postoperative bronchial stump fistula was observed. Perioperative mortality was 1.31 % [n=3 (embolism, cardiac arrest, postop. bleeding)]. Perioperative complications occurred in 6 patients (2.58%) who evolved an empyema. Five patients had been sufficiently treated by VATS debridement and daily drainage irrigation; one achieved an open thoracic window and is still in treatment.

CONCLUSION: We conclude that the bronchial stump protection with a pericardial fat flap can be considered as a highly effective and safe method for the prevention of bronchial stump fistula.

CLINICAL IMPLICATIONS: Since 3/2006 we performed a standardized bronchial stump protection using a pericardial fat flap in every case after pneumonectomy.

DISCLOSURE: Erich Hecker, None.

Monday, October 23, 2006

2:30 PM - 4:00 PM


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