The
most frequent cause of perioperative mortality following bronchoplastic
procedures for malignancy is
A. benign stricture
B. bronchopleural
fistula
C. bronchovascular
fistula
D. local
recurrence
Answer D
Bronchoplastic procedures are performed with increasing
frequency for malignancy. It has
been shown that the survival following sleeve lobectomy is as good as
pneumonectomy. The preservation of
functioning lung parenchyma improves the quality of life compared to the
surgical alternative of pneumonectomy. Bronchoplastic
reconstructions require attention to technical detail to preserve peribronchial
tissue, avoid devascularisation and to minimize tension.
It is wise to wrap the bronchial anastomosis with pleura or pericardial
fat; the surgeon should perform the anastomosis to accommodate any size
discrepancy between the two ends of the bronchi.
Attention to technical detail minimizes the risk of complications.
Intraoperative frozen section should be utilized to be certain of tumor
free margins. Even with this, local
recurrence is still an issue with sleeve lobectomy for malignancy.
In a comprehensive review, Tedder et al. reported a 10.3% incidence of
local recurrence following bronchoplastic procedures for malignancy.
Other complications were much less common.
Complication
No. of patients
Incidence (%)
Local recurrence
110/1064
10.3
Thirty-day mortality
143/1915
7.5
Pneumonia 32/481
6.7
Atelectasis
33/614
5.4
Benign stricture
48/966
5.0
Bronchopleural fistula
42/1186
3.5
Empyema
17/599
2.8
Bronchovascular fistula
16/615
2.6
Pulmonary embolism
13/672
1.9