Predicting prolonged air leak after standard pulmonary lobectomy: computed tomography assessment and risk factors stratification.

BACKGROUND: Prolonged air leak after pulmonary lobectomy is a common time- and cost-consuming complication. Its prevention may significantly reduce hospitalization length and costs offering patients a standard uneventful postoperative course. The aim of the present study is to identify predictors of prolonged postoperative air leak and to stratify preoperative risk factors.
METHODS: From July 2004 to December 2007 241 consecutive standard lobectomies were performed with curative intent for lung cancer. After excluding patients not fulfilling the inclusion criterion, 58 patients were enrolled in the "prolonged air leak" group and 63 patients were enrolled in the "standard outcome" group.
RESULTS: Total lung capacity (p=0.0038) and percentage emphysema (p=0.0050) calculated by computed tomography were both significantly related to prolonged postoperative air leak; the values of 4773cc and 0.4% showed the highest predictive value in terms of sensitivity (84.5% and 75.9% respectively). Multivariate logistic regression disclosed that male sex (p=0.0006), right side of operation (p=0.0010) and age (p=0.0082) were significantly related to prolonged postoperative air leak. Preoperative chemotherapy (p=0.0940) did not affect air leak status.
CONCLUSIONS: Computed tomography quantification of emphysema is the best predictor of prolonged air leak. Age, male sex and right side lobectomy are correlated to this complication. Preoperative chemotherapy is not an additional risk factor.