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: 967
PDF: 229
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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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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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