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.