BRONCHOPLEURAL FISTULA AFTER PNEUMONECTOMY FOR LUNG-CANCER

Bronchopleural fistula (BPF) after pneumonectomy is a life-threatening complication, Over a period of 14 years (January 1980 to November 1993), 471 pneumonectomies were performed by one surgical team using a uniform suture technique for primary lung cancer, Non-small cell lung cancer accounted for 451 cases and 20 cases were small cell cancer. All operations were performed using a uniform hand suture technique. There were seven cases of BPF giving an incidence of 1.5%, All fistulas occurred within 15 days postoperatively and there were no late fistulas, The bronchial stump was free of tumor in all cases, No fistula occurred in the 24 (5.1%) completion pneumonectomies. The experience of the surgeon was important as the senior author performed 374 pneumonectomies with two fistulas (0.5%) while other surgeons in training performed 97 pneumonectomies with five fistulas (5.1%). Bronchial dehiscence was confirmed by bronchoscopy in all cases and an attempt at resuturing the stump through the same thoracotomy incision was made within 2 days of the diagnosis, Closure was successful in five patients, while the other two developed fatal complications, We conclude that suture closure to the bronchial stump after pneumonectomy provides a cheap and reliable technique, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk.