https://doi.org/10.4081/monaldi.2023.2474

Persistent alveolar air leak following pulmonary lobectomy: an old problem in a modern era

Vol. 93 No. 4 (2023)
Submitted: November 4, 2022
Accepted: January 16, 2023
Published: January 26, 2023
pulmonary lobectomy, VATS lobectomy, lung cancer, postoperative air leak
Abstract Views: 769
PDF: 210
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Authors

Dario Amore
darioamoremd@gmail.com
https://orcid.org/0000-0001-9667-8315
Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy.
Umberto Caterino
Department of Respiratory Diseases, Monaldi Hospital, Naples, Italy.
Dino Casazza
Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy.
Riccardo Ievoli
https://orcid.org/0000-0001-9489-3564
Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Italy.
Pasquale Imitazione
Department of Respiratory Diseases, Monaldi Hospital, Naples, Italy.
Alessandro Saglia
Department of Respiratory Diseases, Monaldi Hospital, Naples, Italy.
Alessandro Izzo
Department of Respiratory Diseases, San Giuseppe Moscati Hospital, Avellino, Italy.
Marco Rispoli
Department of Anesthesia and Intensive Care, Monaldi Hospital, Naples, Italy.
Carlo Curcio
Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy.

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.

 

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Scopus
Google Scholar
Europe PMC
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.
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