Risk factors for bronchopleural fistula after pneumonectomy: stump size does matter.

OBJECTIVE: Side- and sex-related differences were analysed to explain the occurrence of bronchopleural fistula (BPF) after pneumonectomy on the right-hand side in men. PATIENTS AND METHODS: Surgical pathology reports on 209 patients (15 with BPF) were retrospectively reviewed regarding sex, age, side, TNM stage, outer diameter of the resection margin (mm) and intrabronchial distance between tumour and resection margin (mm). Patients without macroscopic bronchial invasion were categorised as peripheral tumours. The t-test, U-test (Mann-Whitney) and cross-tabulation using the chi 2-test were performed for univariate statistical analysis. A logistic stepwise backwards regression model was used for multivariate analysis.
RESULTS: Women were significantly younger than men, had a smaller resection margin and fewer central tumours. Stage 4 was overrepresented in women, stage 2 in men. On the right-hand side, the distance was significantly shorter, the resection margin longer and the patients younger. Fistula patients showed a longer resection margin and a shorter distance, men were dominant. Multivariate analysis only identified length of the resection margin as an independent risk factor for BPF (p = 0.024, OR 1.177 CI: 1.033 - 1.356). Gender and side significantly influenced the diameter of the resection margin (p = 0.00).
CONCLUSION: The diameter of the bronchial stump is a major risk factor in the occurrence of post-pneumonectomy BPF, and explains the predominance of the male sex, the right-hand side and pneumonectomy. Where it exceeds 25 mm, prophylactic stump coverage with viable tissue should be performed.