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Bronchial colonization and complications after lung cancer surgery

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Abstract

Purpose

Infectious complications occur following pulmonary resections preceded or not by induction chemoradiotherapy. We aimed to investigate whether bacterial colonization of the bronchial tree at the time of surgery was associated with postoperative complications.

Patients and methods

A retrospective analysis of all patients who underwent open anatomical pulmonary resections for malignancies at a single center was performed. Demographical data of the included patients, intraoperative data, and data on the postoperative course of patients were collected. Outcome of patients with a positive intraoperative bronchial culture was compared to patients with a negative bronchial culture. Relations between the presence of potential bacterial pathogens in the bronchial tree and other possible risk factors for the development of postoperative infectious and non-infectious complications, were analyzed using uni- and multivariate analysis.

Results

Between January 2010 and January 2012, a total of 121 consecutive patients underwent open anatomical pulmonary resections for malignancy, of whom 45 were preceded by induction chemoradiotherapy and 5 by induction chemotherapy. Intraoperative bronchial cultures were taken from 58 patients (48 %). Patients with a positive bronchial culture developed significantly more infectious (88 % vs. 20 %, p < 0.001) and non-infectious complications (63 % vs. 12 %, p = 0.001). Positive intraoperative bronchial cultures showed the strongest association with the development of infectious and non-infectious postoperative complications (OR 24.8 and 12.2, respectively). After multivariate analysis, only BMI less than 20 kg/m2 and the presence of a positive intraoperative bronchial culture were found to be independent risk factors for the development of infectious complications. Chemoradiotherapy was not associated with postoperative complications in the present study.

Conclusions

Bacterial colonization of the bronchial tree assessed intraoperatively, appears to be associated with higher rates of infectious and non-infectious complications after pulmonary resection. Whether early starting of appropriate antibiotics based on intraoperative-taken culture findings will reduce the infectious complication rate in a subcategory of patients needs to be investigated.

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Authors and Affiliations

  1. Department of Surgery, St. Antonius Hospital Nieuwegein, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands

    Jelmer E. Oor

  2. Department of Pulmonary Diseases, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Johannes M. A. Daniels

  3. Department of Clinical Microbiology and Infection Control, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Yvette J. Debets-Ossenkopp

  4. Department of Epidemiology and Biostatistics, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Elly S. M. de Lange-de Klerk

  5. Department of Surgery, MCH/Bronovo/A12 Oncology Center, 2509 JH, The Hague, The Netherlands

    Jan W. A. Oosterhuis

  6. Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Chris Dickhoff

  7. Department of Cardio-Thoracic Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Chris Dickhoff

  8. Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Koen J. Hartemink

Authors
  1. Jelmer E. Oor
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  2. Johannes M. A. Daniels
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  3. Yvette J. Debets-Ossenkopp
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  4. Elly S. M. de Lange-de Klerk
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  5. Jan W. A. Oosterhuis
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  6. Chris Dickhoff
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  7. Koen J. Hartemink
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Corresponding author

Correspondence to Jelmer E. Oor.

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There was no funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Authors’ contributions

-Study conception and design: Oor, Daniels, Debets-Ossenkopp, Dickhoff, Hartemink

-Acquisition of data: Oor, Hartemink

-Analysis and interpretation of data: Oor, Daniels, Debets-Ossenkopp, de Lange-de Klerk, Oosterhuis, Dickhoff, Hartemink

-Drafting of manuscript: Oor, Daniels, de Lange-de Klerk, Debets-Ossenkopp, Oosterhuis, Dickhoff, Hartemink

-Critical revision of manuscript: Daniels, Debets-Ossenkopp, de Lange-de Klerk, Oosterhuis, Dickhoff, Hartemink

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Oor, J.E., Daniels, J.M.A., Debets-Ossenkopp, Y.J. et al. Bronchial colonization and complications after lung cancer surgery. Langenbecks Arch Surg 401, 885–892 (2016). https://doi.org/10.1007/s00423-016-1487-z

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  • DOI: https://doi.org/10.1007/s00423-016-1487-z

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