Chest
Clinical Investigations: SurgeryProlonged Air Leak Following Radical Upper Lobectomy: An Analysis of Incidence and Possible Risk Factors†,
Section snippets
MATERIALS AND METHODS
The records of 100 consecutive patients, retrieved from a prospective database, who had undergone a right upper lobectomy for NSCLC by the same surgeon (M.B.) at Memorial Sloan-Kettering Cancer Center from September 1988 through May 1996 were examined retrospectively. Patients with Pancoast tumors and tumors requiring bilobectomy, pneumonectomy, or chest wall resection were excluded. A PAL was defined as an air leak requiring >7 days of postoperative chest tube drainage. A chest tube required
RESULTS
Thirty-eight women and 62 men, with a median age of 66 years (range, 41 to 81 years), were included in this analysis. All resections were performed through a standard posterolateral thoracotomy and included a complete mediastinal lymph node dissection. In 10 patients, a concomitant right lower lobe superior segmentectomy or wedge resection was performed. All patients were extubated either in the operating room or immediately after transfer to the recovery room.
The postoperative course was
DISCUSSION
Pulmonary lobectomies frequently require division across the lung parenchyma and, therefore, inherently create a potential source for parenchymal air leaks. In most instances, the air leak seals rapidly when the visceral pleura becomes adherent to the chest wall, and the chest tube is removed uneventfully. However, upper lobectomies often result in large apical air spaces with poor visceral-parietal pleural apposition, and thus, frequently predispose these patients to longer pulmonary air leaks.
CONCLUSION
PAL represents a major source of morbidity and is the most frequent cause of an extended length of hospitalization in patients undergoing upper lobectomy for NSCLC. It behooves thoracic surgeons to be cognizant of this iatrogenic complication and actively participate in developing more effective strategies to prevent it.
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2022, Asian Journal of SurgeryCitation Excerpt :Of 30 risk factors, 29 were evaluated to be low or very low evidence quality (see Supplementary Table S2). Of 24 studies2,5,9,18–38 examined the relationship between age and PAL incidence, the number of studies was, by variable type of age: both binary and continuous, 49, 18-20; binary, 82, 9, 18-23; continuous, 205, 9, 18, 20, 24-37. We found that advanced age was a non-significant risk factor for PAL as a binary variable (OR = 1.40, 95%CrI 0.87 to 2.37, P = 0.051), while significant as a continuous variable (MD = 1.82, 95%CrI 1.04 to 2.58, P<0.001) (Fig. 3).
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Deceased.
Reprint requests: Ari Brooks, MD, Memorial Sloan-Kettering Cancer Center, Thoracic Service, Department of Surgery, 1275 York Ave, New York, NY 10021