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The integrated place of tracheobronchial stents in the multidisciplinary management of large post-pneumonectomy fistulas: our experience using a novel customised conical self-expandable metallic stent
- Source :
- European Journal of Cardio-Thoracic Surgery. 39:185-189
- Publication Year :
- 2011
- Publisher :
- Oxford University Press (OUP), 2011.
-
Abstract
- Stump dehiscence after pneumonectomy is a cause of morbidity and mortality in patients treated for non-small-cell lung carcinoma. Surgical repair remains the treatment of choice but can be postponed or contraindicated. Bronchoscopic techniques may be an option with curative intent or as a bridge towards definitive surgery. The aim of the study is to evaluate the efficacy and the outcome of a new customised covered conical self-expandable metallic stent in the management of large bronchopleural fistulas complicating pneumonectomies.A case series using chart review of non-operable patients presenting with large bronchopleural fistulas (6mm) post-pneumonectomies as a definitive treatment with curative intent for non-small-cell lung carcinomas and requiring the use of a dedicated conical shaped stent in two tertiary referral centres.Seven patients presenting large post-pneumonectomy fistulas (between 6 and 12 mm) were included. Cessation of the air leak and clinical improvement was achieved in all the patients after stent placement. Stent-related complications (two migrations and one stent rupture) were successfully managed using bronchoscopic techniques in two patients and surgery in one. Mortality, mainly related to overwhelming sepsis, was 57%. Delayed definitive surgery was achieved successfully in three patients (43%).This case series assesses the short-term clinical efficacy of a new customised covered conical self-expandable metallic stent in the multidisciplinary management of large bronchopleural fistulas complicating pneumonectomies in patients deemed non-operable. Long-term benefits are jeopardised by infectious complications.
- Subjects :
- Adult
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Lung Neoplasms
medicine.medical_treatment
Bronchopleural fistula
Dehiscence
Prosthesis Design
Pneumonectomy
Self-expandable metallic stent
Carcinoma, Non-Small-Cell Lung
Chart review
Surgical Wound Dehiscence
Humans
Medicine
Aged
Surgical repair
business.industry
Stent
General Medicine
Middle Aged
Pleural Diseases
medicine.disease
Surgery
Treatment Outcome
Stents
Bronchial Fistula
Radiology
Respiratory Tract Fistula
Cardiology and Cardiovascular Medicine
business
Complication
Subjects
Details
- ISSN :
- 10107940
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- European Journal of Cardio-Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....3b0b7433073399599eaeec2e6d6b40a8