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Prolonged air leak following lobectomy can be predicted in lung cancer patients

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Abstract

Purpose

The purpose of this study was to identify the factors associated with prolonged air leak (PAL) following pulmonary lobectomy for lung cancer.

Methods

The data of 146 patients who underwent pulmonary lobectomy for lung cancer between August 2010 and July 2015 were retrospectively reviewed. Air leaks were assessed daily by a visual evaluation and were categorized as follows: forced expiratory only (Grade 1), expiratory only (Grade 2), or continuous (Grade 3). Logistic regression analyses were performed to identify the predictors of PAL (>5 days).

Results

PAL occurred in 23 patients (16%). An air leak at rest (Grade ≥ 2) was detected on postoperative day (POD) 1 in 48% of the patients with PAL and 7% of the patients without PAL. A univariate analysis demonstrated that PAL was significantly associated with male sex, a smoking history of ≥ 40 pack years, a serum albumin level of ≤4.0 mg/dL, and an air leak on POD1 (Grade ≥ 2). A multivariate analysis demonstrated that a serum albumin level of ≤4.0 mg/dL (p = 0.027) and an air leak on POD1 (p = 0.006) were independent predictors of PAL. PAL occurred in 75% of the patients with these two risk factors.

Conclusions

The preoperative serum albumin level and the presence of a visually evaluated air leak on POD1 may be useful indicators for the perioperative management of air leaks.

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References

  1. ESTS Database Annual Report. Silver Book, 2016. http://www.ests.org/_userfiles/pages/files/ESTS%202016Silver_Book_FULL_FINAL_14.50.pdf. Accessed 2016.

  2. Abolhoda A, Liu D, Brooks A, Burt M. Prolonged air leak following radical upper lobectomy: an analysis of incidence and possible risk factors. Chest. 1998;113:1507–10.

    Article  CAS  PubMed  Google Scholar 

  3. Brunelli A, Xiume F, Al Refai M, Salati M, Marasco R, Sabbatini A. Air leaks after lobectomy increase the risk of empyema but not of cardiopulmonary complications: a case-matched analysis. Chest. 2006;130:1150–6.

    Article  PubMed  Google Scholar 

  4. Varela G, Jiménez MF, Novoa N, Aranda JL. Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg. 2005;27:329–33.

    Article  PubMed  Google Scholar 

  5. Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000;118:1263–70.

    Article  CAS  PubMed  Google Scholar 

  6. Orsini B, Baste JM, Gossot D, Berthet JP, Assouad J, Dahan M, et al. Index of prolonged air leak score validation in case of video-assisted thoracoscopic surgery anatomical lung resection: results of a nationwide study based on the French national thoracic database, EPITHOR. Eur J Cardiothorac Surg. 2015;48:608–11.

    Article  PubMed  Google Scholar 

  7. Rivera C, Bernard A, Falcoz PE, Thomas P, Schmidt A, Benard S, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg. 2011;92:1062–8.

    Article  PubMed  Google Scholar 

  8. Lee L, Hanley SC, Robineau C, Sirois C, Mulder DS, Ferri LE. Estimating the risk of prolonged air leak after pulmonary resection using a simple scoring system. J Am Coll Surg. 2011;212:1027–32.

    Article  PubMed  Google Scholar 

  9. Brunelli A, Monteverde M, Borri A, Salati M, Marasco RD, Fianchini A. Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg. 2004;77:1205–10.

    Article  PubMed  Google Scholar 

  10. Elsayed H, McShane J, Shackcloth M. Air leaks following pulmonary resection for lung cancer: is it a patient or surgeon related problem? Ann R Coll Surg Engl. 2012;94:422–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Stolz AJ, Schützner J, Lischke R, Simonek J, Pafko P. Predictors of prolonged air leak following pulmonary lobectomy. Eur J Cardiothorac Surg. 2005;27:334–6.

    Article  PubMed  Google Scholar 

  12. Isowa N, Hasegawa S, Bando T, Wada H. Preoperative risk factors for prolonged air leak following lobectomy or segmentectomy for primary lung cancer. Eur J Cardiothorac Surg. 2002;21:951.

    Article  PubMed  Google Scholar 

  13. Brunelli A, Cassivi SD, Salati M, Fibla J, Pompili C, Halgren LA, et al. Digital measurements of air leak flow and intrapleural pressures in the immediate postoperative period predict risk of prolonged air leak after pulmonary lobectomy. Eur J Cardiothorac Surg. 2011;39:584–8.

    Article  PubMed  Google Scholar 

  14. Gómez-Caro A, Calvo MJ, Lanzas JT, Chau R, Cascales P, Parrilla P. The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy. Eur J Cardiothorac Surg. 2007;31:203–8.

    Article  PubMed  Google Scholar 

  15. Stamenovic D, Bostanci K, Messerschmidt A, Jahn T, Schneider T. Fissureless fissure-last video-assisted thoracoscopic lobectomy for all lung lobes: a better alternative to decrease the incidence of prolonged air leak? Eur J Cardiothorac Surg. 2016;50:118–23.

    Article  PubMed  Google Scholar 

  16. Bille A, Borasio P, Gisabella M, Errico L, Lausi P, Lisi E, et al. Air leaks following pulmonary resection for malignancy: risk factors, qualitative and quantitative analysis. Interact Cardiovasc Thorac Surg. 2011;13:11.5.

    Article  PubMed  Google Scholar 

  17. Brunelli A, Al Refai M, Monteverde M, Borri A, Salati M, Sabbatini A, et al. Pleural tent after upper lobectomy: a randomized study of efficacy and duration of effect. Ann Thorac Surg. 2002;74:1958–62.

    Article  PubMed  Google Scholar 

  18. Liberman M, Muzikansky A, Wright CD, Wain JC, Donahue DM, Allan JS, et al. Incidence and risk factors of persistent air leak after major pulmonary resection and use of chemical pleurodesis. Ann Thorac Surg. 2010;89:891–7.

    Article  PubMed  Google Scholar 

  19. Muta F, Takamori S, Matsuo T, Iwasaki Y, Yoshiyama K, Shirouzu K. Changes in the pleural cavity by pleurodesis using talc or OK-432: an experimental study. Surg Today. 2011;41:111–4.

    Article  PubMed  Google Scholar 

  20. How CH, Tsai TM, Kuo SW, Huang PM, Hsu HH, Lee JM, et al. Chemical pleurodesis for prolonged postoperative air leak in primary spontaneous pneumothorax. J Formos Med Assoc. 2014;113:284–90.

    Article  CAS  PubMed  Google Scholar 

  21. Cerfolio RJ, Tummala RP, Holman WL, Zorn GL, Kirklin JK, McGiffin DC, et al. A prospective algorithm for the management of air leaks after pulmonary resection. Ann Thorac Surg. 1998;66:1726–31.

    Article  CAS  PubMed  Google Scholar 

  22. Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–85.

    Article  PubMed  Google Scholar 

  23. Masuda M, Kuwano H, Okumura M, Arai S, Endo S, Doki Y, et al. Thoracic and cardiovascular surgery in Japan during 2013: Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2015;63:670–701.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Iwata T, Nagato K, Nakajima T, Suzuki H, Yoshida S, Yoshino I. Risk factors predictive of atrial fibrillation after lung cancer surgery. Surg Today. 2016;46:877–86.

    Article  PubMed  Google Scholar 

  25. Yamamoto T, Suzuki H, Nagato K, Nakajima T, Iwata T, Yoshida S, et al. Is left upper lobectomy for lung cancer a risk factor for cerebral infarction? Surg Today. 2016;46:780–4.

    Article  PubMed  Google Scholar 

  26. Irvin TT, Hunt TK. Effect of malnutrition on colonic healing. Ann Surg. 1974;180:765–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Busch E, Verazin G, Antkowiak JG, Driscoll D, Takita H. Pulmonary complications in patients undergoing thoracotomy for lung carcinoma. Chest. 1994;105:760–6.

    Article  CAS  PubMed  Google Scholar 

  28. Pompili C, Salati M, Refai M, Xiumé F, Sabbatini A, Tiberi M, et al. Recurrent air leak soon after pulmonary lobectomy: an analysis based on an electronic airflow evaluation. Eur J Cardiothorac Surg. 2016;49:1091–4.

    Article  PubMed  Google Scholar 

  29. Gilbert S, McGuire AL, Maghera S, Sundaresan SR, Seely AJ, Maziak DE, et al. Randomized trial of digital versus analog pleural drainage in patients with or without a pulmonary air leak after lung resection. J Thorac Cardiovasc Surg. 2015;150:1243–9.

    Article  PubMed  Google Scholar 

  30. Rodríguez M, Jiménez MF, Hernández MT, Novoa NM, Aranda JL, Varela G. Usefulness of conventional pleural drainage systems to predict the occurrence of prolonged air leak after anatomical pulmonary resection. Eur J Cardiothorac Surg. 2015;48:612–5.

    Article  PubMed  Google Scholar 

  31. Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis. 2014;6:271–84.

    PubMed  PubMed Central  Google Scholar 

  32. Brunelli A, Monteverde M, Borri A, Salati M, Marasco RD, Al Refai M, et al. Comparison of water seal and suction after pulmonary lobectomy: a prospective, randomized trial. Ann Thorac Surg. 2004;77:1932–7.

    Article  PubMed  Google Scholar 

  33. Leo F, Duranti L, Girelli L, Furia S, Bille A, Garofalo G, et al. Does external pleural suction reduce prolonged air leak after lung resection? Results from the AirINTrial after 500 randomized cases. Ann Thorac Surg. 2013;96:1234–9.

    Article  PubMed  Google Scholar 

  34. Bharat A, Graf N, Mullen A, Kanter J, Andrei AC, Sporn PH, et al. Pleural hypercarbia after lung surgery is associated with persistent alveolopleural fistulae. Chest. 2016;149:220–7.

    Article  PubMed  Google Scholar 

  35. Cummins EP, Selfridge AC, Sporn PH, Sznajder JI, Taylor CT. Carbon dioxide-sensing in organisms and its implications for human disease. Cell Mol Life Sci. 2014;71:831–45.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachidori-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Satoru Okada, Junichi Shimada, Daishiro Kato, Hiroaki Tsunezuka & Masayoshi Inoue

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  1. Satoru Okada
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  2. Junichi Shimada
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  3. Daishiro Kato
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  4. Hiroaki Tsunezuka
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  5. Masayoshi Inoue
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Correspondence to Masayoshi Inoue.

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The authors declare no conflicts of interest in association with the present study.

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Okada, S., Shimada, J., Kato, D. et al. Prolonged air leak following lobectomy can be predicted in lung cancer patients. Surg Today 47, 973–979 (2017). https://doi.org/10.1007/s00595-016-1467-5

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  • DOI: https://doi.org/10.1007/s00595-016-1467-5

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