• Shuji Haraguchi, Kiyoshi Koizumi, Masafumi Hioki, Tomomi Hirata, Kyoji Hirai, Iwao Mikami, Hirotoshi Kubokura, Yutaka Enomoto, Hiroyasu Kinoshita, and Kazuo Shimizu.
• Department of Surgery, Nippon Medical School Musashi Kosugi Hospital, Tokyo, Japan. shuji@nms.ac.jp
• J Nippon Med Sch. 2006 Dec 1; 73 (6): 314-9.

BackgroundBronchopleural fistula is a potentially fatal complication of pulmonary resections, especially pneumonectomy.MethodsUnivariate and multivariate analyses of the development of bronchopleural fistula were performed in 12 patients with bronchopleural fistula and 102 patients without bronchopleural fistula who had undergone pneumonectomy from January 1983 through December 2005.ResultsBronchopleural fistula developed after pneumonectomy in 12 patients (8.5%). Seven (58.7%) of the 12 patients died of bronchopleural fistula. Univariate analysis showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease significantly contributed to the development of postpneumonectomy bronchopleural fistula (p=0.0002, p=0.0043, and p=0.0387, respectively). Multivariate analysis also showed that preoperative infection, right pneumonectomy, and pathological N2, 3 disease were significant risk factors for postpneumonectomy bronchopleural fistula.ConclusionsBronchopleural fistula is strongly associated with preoperative infection, right pneumonectomy, and pathological N2, 3 disease. Bronchial stump coverage with pedicled tissue flaps and preservation of the bronchial arteries during mediastinal lymph node dissection are recommended to maintain the blood supply to the bronchial stump in patients at risk.

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