https://doi.org/10.4081/monaldi.2023.2474
Persistent alveolar air leak following pulmonary lobectomy: an old problem in a modern era
Submitted: November 4, 2022
Accepted: January 16, 2023
Published: January 26, 2023
Accepted: January 16, 2023
Abstract Views: 769
PDF: 210
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Persistent alveolar air leak (PAAL) after major lung resection remains a common complication in thoracic surgery. The aim of this study was to identify a subset of patients with high risk of developing PAAL after pulmonary lobectomy. Another objective was to evaluate the influence of PAAL on postoperative complications and length of hospital stay. A retrospective analysis on 895 patients undergoing pulmonary lobectomy from January 2014 to December 2019 was performed. PAAL was defined as air leak lasting more than 5 days after lung surgery. Univariate analyses and logistic regressions were performed to identify the predictors of PAAL. A backward selection algorithm was used to identify the optimal set of predictors. The incidence of PAAL was 8.2% (74/895). Male gender (p=0.017), BMI (p<0.001), transient ischemic attack (p=0.031), FEV1 (p=0.018), lobectomy combined with adjacent subsegmentectomy (p=0.018), partial and extended pleural adhesions (p=0.033 and p=0.038, respectively) were identified as independent risk factors for PAAL through logistic regression. A weak positive correlation was found between video-assisted thoracic surgery (VATS) and PAAL following pulmonary lobectomy (p=0.100). PAAL was found to be associated with higher risk of postoperative morbidity (p=0.002) and with longer hospital stay (p<0.001). Both preoperative and intraoperative risk factors may be responsible for PAAL after pulmonary lobectomy. VATS does not appear to prevent this postoperative complication. An alveolar air leak lasting beyond 5 days after pulmonary lobectomy is associated with worse postoperative outcomes.
Cerfolio RJ. Early postoperative complications. In: Patterson GA, Cooper JD, Deslauriers J, et al. editors. Pearson’s Thoracic & Esophageal Surgery 3rded. Churchill Livingstone, Philadelphia: 2008. pp. 160-165.
DOI: https://doi.org/10.1016/B978-0-443-06861-4.50016-2
Varela G, Jimènez MF, Novoa N, Aranda JL. Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg 2005;27:329-33.
DOI: https://doi.org/10.1016/j.ejcts.2004.11.005
Keagy BA, Lores ME, Starek PJ, et al. Elective pulmonary lobectomy: factors associated with morbidity and operative mortality. Ann Thorac Surg 1985;40:349-52.
DOI: https://doi.org/10.1016/S0003-4975(10)60065-3
Zhao K, Mei J, Xia C, et al. Prolonged air leak after video-assisted thoracic surgery lung cancer resection: risk factors and its effect on postoperative clinical recovery. J Thorac Dis 2017; 9:1219-25.
DOI: https://doi.org/10.21037/jtd.2017.04.31
Rice TW, Kirby TTJ. Prolonged air leak. Chest Surg Clin North Am 1992;2:803-11.
Clark JM, Cooke DT, Brown LM. Management of complications after lung resection: prolonged air leak and bronchopleural fistula. Thorac Surg Clin 2020;30:347-58.
DOI: https://doi.org/10.1016/j.thorsurg.2020.04.008
Brunelli A, Monteverde M, Borri A, et al. Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg 2004;77:1205-10.
DOI: https://doi.org/10.1016/j.athoracsur.2003.10.082
Brunelli A, Varela G, Refai M, et al. A scoring system to predict the risk of prolonged air leak after lobectomy. Ann Thorac Surg 2010;90:204-9.
DOI: https://doi.org/10.1016/j.athoracsur.2010.02.054
Cerfolio RJ, Pickens A, Bass C, Katholi C. Fast-tracking pulmonary resections. J Thorac Cardiovasc Surg 2001;122:318-24.
DOI: https://doi.org/10.1067/mtc.2001.114352
Seder CW, Basu S, Ramsay T, et al. A prolonged air leak score for lung cancer resection: an analysis of the Society of Thoracic Surgeons General Thoracic Surgery Database. Ann Thorac Surg 2019;108:1478-83.
DOI: https://doi.org/10.1016/j.athoracsur.2019.05.069
French DG, Plourde M, Henteleff H, et al. Optimal management of postoperative parenchymal air leaks. J Thorac Dis 2018;10:S3789-98.
DOI: https://doi.org/10.21037/jtd.2018.10.05
Pompili C, Falcoz PE, Salati M, et al. A risk score to predict the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy: an analysis from the European Society of Thoracic Surgeons database. J Thorac Cardiovasc Surg 2017;153:957-65.
DOI: https://doi.org/10.1016/j.jtcvs.2016.11.064
Rivera C, Bernard A, Falcoz PE, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg 2011;92:1062-8.
DOI: https://doi.org/10.1016/j.athoracsur.2011.04.033
Lee L, Hanley SC, Robineau C, et al. Estimating the risk of prolonged air leak after pulmonary resection using a simple scoring system. J Am Coll Surg 2011;212:1027-32.
DOI: https://doi.org/10.1016/j.jamcollsurg.2011.03.010
Viti A, Socci L, Congregado M, et al. The everlasting issue of prolonged air leaks after lobectomy for non-small cell lung cancer: A data-driven prevention planning model in the era of minimally invasive approaches. J Surg Oncol 2018;118:1285-91.
DOI: https://doi.org/10.1002/jso.25289
Elsayed H, McShane J, Shackcloth M. Air leaks following pulmonary resection for lung cancer: is it a patient or surgeon related problem? Ann R Coll Surg Engl 2012;94:422-7.
DOI: https://doi.org/10.1308/003588412X13171221592258
Okereke I, Murthy SC, Alster JM, et al. Characterization and importance of air leak after lobectomy. Ann Thorac Surg 2005;79:1167-73.
DOI: https://doi.org/10.1016/j.athoracsur.2004.08.069
Bardell T, Petsikas D. What keeps postpulmonary resection patients in hospital? Can Respir J 2003;10:86-9.
DOI: https://doi.org/10.1155/2003/610570
Irshad K, Feldman LS, Chu VF, et al. Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study. Can J Surg 2002;45:264-8.
Lang-Lazdunski L, Coonar AS. A prospective study of autologous ‘blood patch’ pleurodesis for persistent air leak after pulmonary resection. Eur J Cardiothorac Surg 2004;26:897-900.
DOI: https://doi.org/10.1016/j.ejcts.2004.07.034
How to Cite
Amore, Dario, Umberto Caterino, Dino Casazza, Riccardo Ievoli, Pasquale Imitazione, Alessandro Saglia, Alessandro Izzo, Marco Rispoli, and Carlo Curcio. 2023. “Persistent Alveolar Air Leak Following Pulmonary Lobectomy: An Old Problem in a Modern Era”. Monaldi Archives for Chest Disease 93 (4). https://doi.org/10.4081/monaldi.2023.2474.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Dario Tino Bertolone, Cristina De Colle, Francesco Rozza, Ilaria Fucile, Ciro Santoro, Maurizio Conte, Nicola De Luca, Costantino Mancusi, Lung ultrasound: a narrative review and proposed protocol for patients admitted to Cardiac Rehabilitation Unit , Monaldi Archives for Chest Disease: Vol. 92 No. 1 (2022)
- Manu Madan, Rohit Kumar, Pranav Ish, Yash Kedia, AJ Mahendran, Rajnish Kaushik, Neeraj Kumar Gupta, Nitesh Gupta, Additional yield of transbronchial cryo-node biopsy over endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lesions at a tertiary care center in India (COLD-FORCEPS-2 study) , Monaldi Archives for Chest Disease: Early Access
- Daniele Magnini, Emilio Bria, Alessandra Cancellieri, Vanina Livi, Fausto Leoncini, Marco Ferrari, Teresa Bruni, Daniela Paioli, Rocco Trisolini, Bronchoscopically-visible massive central airway cancer cavitation is associated with metastatic disease, lack of actionable mutations and poor prognosis: a case series , Monaldi Archives for Chest Disease: Early Access
- Davorka Muršić, Tajana Jalušić Glunčić, Jelena Ostojić, Sanda Škrinjarić Cincar, Ljiljana Bulat Kardum, Martina Dokoza, Nataša Karamarković Lazarušić, Erim Bešić, Miroslav Samaržija, Andrea Vukić Dugac, Differences in nutritional status of patients with chronic obstructive pulmonary disease between Mediterranean and non-Mediterranean regions in Croatia , Monaldi Archives for Chest Disease: Early Access
- Shayan Shahid, Ali bin Abdul Jabbar, Abdullah Wagley, Muhammad Daniyal Musharraf, Haris Zahid, Syed Muhammad Zubair, Muhammad Irfan, Non-cystic fibrosis bronchiectasis: a retrospective review of clinical, radiological, microbiological and lung function profile at a tertiary care center of low-middle income country , Monaldi Archives for Chest Disease: Early Access
- Ravi Manglani, Moshe Fenster, Theresa Henson, Ananth Jain, Neil Schluger, Clinical characteristics, imaging, and lung function among patients with persistent dyspnea of COVID-19: a retrospective observational cohort study , Monaldi Archives for Chest Disease: Early Access
- Muniza Bai, Vishnukanth Govindaraj, Abhishek Singh Chauhan, Bheemanati Hanuman Srinivas, Jinkala Sree Rekha, Vijayarangam Narenchandra, Metastatic malignant peripheral nerve sheath tumor. A diagnostic surprise , Monaldi Archives for Chest Disease: Vol. 91 No. 2 (2021)
- Anna Jacob, Kranti Garg, Kashish Dutta, Varinder Saini, Deepak Aggarwal, Ajeet Sidana, Role of detailed psychological evaluation and treatment in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease , Monaldi Archives for Chest Disease: Early Access
- Mamta Singh, Kunal Deokar, Bibhuti Prassan Sinha, Jinish Doshi, CDS Katoch, Infective pulmonary diseases and the eye: a narrative review , Monaldi Archives for Chest Disease: Early Access
- Zeynep Çınar, Eda Macit Aydın, Nurgul Naurzvai, Ayshan Mammadova, Sümeyye Kodalak, Aygül Abbasova, Gül Gürsel, Impact of neurological problems on mechanical ventilation and intensive care unit outcomes in pulmonary intensive care unit patients: a retrospective analysis of a single-center cohort , Monaldi Archives for Chest Disease: Vol. 94 No. 1 (2024)
<< < 17 18 19 20 21 22 23 24 25 26 > >>
You may also start an advanced similarity search for this article.
