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Risk factors for bronchopleural fistula based on surgical procedure and sex in 4794 consecutive patients undergoing anatomical pulmonary resection

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Abstract

Purpose

Bronchopleural fistula (BPF) is a lethal complication, even in the modern era. Therefore, we investigated the details of patients with BPF to select an appropriate surgical strategy.

Methods

This retrospective study included 4794 consecutive patients who underwent anatomical pulmonary resection between 2008 and 2022. We evaluated the predictors of BPF using a multivariable analysis and investigated the mortality and clinical course after BPF in detail.

Results

BPF was observed in 32 patients (0.67%). In the multivariable analysis, the predictors for BPF were male sex (odds ratio [OR], 6.91), the body mass index (OR, 2.40), the vital capacity (%VC) (OR, 2.93), surgery performed (right lower lobectomy [OR, 10.92], right middle and lower lobectomy [OR, 6.97], and right pneumonectomy [OR, 16.68]), and additional resection of surrounding organs (OR, 3.47). Among the risk factors, surgery performed and male sex were very strong risk factors, with the frequency itself very low in females (0.1%). The 90-day mortality was 15.6%, and the 5-year overall survival in patients with BPF was 28.1%.

Conclusion

Our study revealed that independent risk factors and consideration of the surgical methods and sex might help determine whether or not special attention should be given to the bronchial stump, which will be of great help in surgical strategies.

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Data availability

All relevant data are within the manuscript, and other detailed data cannot be shared publicly because of the privacy of individuals.

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Acknowledgements

This study was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health, Labor, and Welfare of Japan and the Smoking Research Foundation. The authors thank Hisashi Tomita for providing technical support. We would also like to thank Editage (www.editage.com) for the English language editing.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-Chome, Bunkyo-ku, Tokyo, 113-8431, Japan

    Takeshi Matsunaga, Kenji Suzuki, Aritoshi Hattori, Mariko Fukui & Kazuya Takamochi

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  1. Takeshi Matsunaga
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  2. Kenji Suzuki
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Correspondence to Takeshi Matsunaga.

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Ethical approval

This retrospective study was performed under a waiver of authorization and approved by the Institutional Review Board of our institute (no. E22-0419).

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Matsunaga, T., Suzuki, K., Hattori, A. et al. Risk factors for bronchopleural fistula based on surgical procedure and sex in 4794 consecutive patients undergoing anatomical pulmonary resection. Surg Today 54, 617–626 (2024). https://doi.org/10.1007/s00595-023-02761-2

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  • DOI: https://doi.org/10.1007/s00595-023-02761-2

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