Abstract
Objective
Respiratory complications are critical events after sleeve lobectomy. A caliber mismatch is an important factor in wound healing at the anastomotic site. This study aimed to determine the influence of caliber mismatches on patients’ clinical courses after sleeve lobectomy.
Methods
We investigated the clinical courses of 56 patients with primary lung cancer who underwent pulmonary resection with end-to-end bronchoplasty. Anastomoses between the main bronchus and the segmental, right upper or middle bronchus, and between the trunks intermedius and the segmental or middle bronchus are categorized as an “anastomosis with caliber mismatch”.
Results
Among the 56 patients, 22 underwent bronchoplasty with caliber mismatch. There were no in-hospital deaths, and the mortality rates at the 30- and 90-day evaluations were zero. Respiratory complications (n = 10, 52%, p = 0.005), such as pneumonia (n = 7, 32%, p = 0.029), retention of pleural effusion (n = 6, 27%, p = 0.026) and bronchopleural fistula (n = 3, 14%, p = 0.027), were significantly increased after bronchoplasty with caliber mismatch. Lower body mass index (BMI) is a significant risk factor for respiratory complications after sleeve lobectomy with caliber mismatch (median value; 23.2 vs 21.2, p = 0.036).
Conclusions
Significant respiratory complications are apparent after bronchoplasty with caliber mismatch, especially patients with low BMI have a high risk of respiratory complications. Appropriate patient selection and cautious perioperative management are mandatory for this type of lung-preserving surgery.
Similar content being viewed by others
References
Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H, Satake S, et al. Extended sleeve lobectomy for lung cancer: the avoidance of pneumonectomy. J Thorac Cardiovasc Surg. 1999;118:710–3.
Berthet JP, Paradela M, Jimenez MJ, Molins L, Gómez-Caro A. Extended sleeve lobectomy: one more step toward avoiding pneumonectomy in centrally located lung cancer. Ann Thorac Surg. 2013;96:1988–97.
Miyoshi S, Tamura M, Araki O, Yoshii N, Karube Y, Seki N, et al. Telescoping bronchial anastomosis for extended sleeve lobectomy. J Thorac Cardiovasc Surg. 2006;132:978–80.
Hollaus PH, Janakiev D, Pridun NS. Telescope anastomosis in bronchial sleeve resections with high-caliber mismatch. Ann Thorac Surg. 2001;72:357–61.
Ohata K, Zhang J, Ito S, Yoshimura T, Matsubara Y, Terada Y. Right lower lobe sleeve resection: bronchial flap to correct caliber disparity. Ann Thorac Surg. 2013;95:1107–8.
Toyooka S, Soh J, Oto T, Miyoshi S. Bronchoplasty to adjust mismatches in the proximal and distal bronchial stumps during bronchial sleeve resection of the left lower lobe and lingular division. Eur J Cardiothorac Surg. 2013;43:182–3.
Nakagawa T, Toyazaki T, Chiba N, Ueda Y, Gotoh M. Prognostic value of body mass index and change in body weight in postoperative outcomes of lung cancer surgery. Interact Cardiovasc Thorac Surg. 2016;23:560–6.
Maurizi G, D’Andrilli A, Anile M, Ciccone AM, Ibrahim M, Venuta F, et al. Sleeve lobectomy compared with pneumonectomy after induction therapy for non-small-cell lung cancer. J Thorac Oncol. 2013;8:637–43.
Gonzalez M, Litzistorf Y, Krueger T, Popeskou SG, Matzinger O, Ris HB, et al. Impact of induction therapy on airway complications after sleeve lobectomy for lung cancer. Ann Thorac Surg. 2013;96:247–52.
Toyooka S, Soh J, Yamamoto H, Yamane M, Hattori S, Shien K, et al. Extended sleeve lobectomy after induction chemoradiotherapy for non-small cell lung cancer. Surg Today. 2015;45:1121–6.
Comacchio GM, Schiavon M, Azzolina D, Mammana M, Marulli G, Zuin A, et al. Does induction therapy increase anastomotic complications in bronchial sleeve resections? World J Surg. 2019;43:1385–92.
Forde PM, Chaft JE, Smith KN, Anagnostou V, Cottrell TR, Hellmann MD, et al. Neoadjuvant PD-1 blockade in resectable lung cancer. N Engl J Med. 2018;378:1976–86.
Bott MJ, Yang SC, Park BJ, Adusumilli PS, Rusch VW, Isbell JM, et al. Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non-small cell lung cancer. J Thorac Cardiovasc Surg. 2019;158:269–76.
Kocaturk CI, Saydam O, Sezen CB, Kalafat CE, Cansever L, Kutluk AC, et al. Is right sleeve lower lobectomy necessary? Is it safe? Thorac Cardiovasc Surg. 2020;68:235–40.
Moriyama S, Yano M, Sasaki H, Hikosaka Y, Yokota K, Fujii Y. Middle lobe preservation and fixation: right upper and lower sleeve bilobectomy. How to do it. Surg Today. 2012;42:610–2.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tsukioka, T., Izumi, N., Komatsu, H. et al. Influence of caliber mismatch on patients’ clinical course after sleeve lobectomy. Gen Thorac Cardiovasc Surg 69, 1079–1085 (2021). https://doi.org/10.1007/s11748-020-01582-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-020-01582-1