| Objective: Bronchopleural fistula after pneumonectomy is a very seriouscomplication with a reported incidence between 0.8% and 12.5% in the westerncountries. The aim of this retrospective study is to investigate the incidence ofbronchopleural fistula and analyze risk factors affecting this incidence bycollecting consecutive series pneumonectomies for primary lung cancer in LavalHospital and clarify the indication of preventive coverage of bronchial stumps toavoid this particular complication. Methods: We reviewed 1046 consecutivepatients undergoing pneumonectomy for primary lung cancer. Bronchial stumpclosure was performed by means of stapling devices in 1032 patients (98.7%).Perioperative data were recorded to identify risk factors of bronchopleural fistulaby univariate and multivariate analysis. Results: Perioperative mortality ofpneumonectomy was 5.3%. Bronchopleural fistula occurred in 32 patients only(3.1%). Two patients (6.3%) died of this complication. By univariate analysis,patients undergoing pneumonectomy with right side (p<0.0001), incompleteresection (p=0.0394), transfusion (p=0.0055), perioperative blood loss (>495ml)(p=0.0081) were related with higher risk of bronchopleural fistula. Bymultivariate analysis, patients undergoing pneumonectomy with right side(R=12.019, P<0.0001), incomplete resection (R=2.365, P=0.0328), transfusion(R=2.759, P=0.0049), perioperative blood loss (>495ml) (R=2.607, P=0.0161)were independent risk factors to bronchopleural fistula. Conclusion: Closingbronchial stump by staple in pneumonectomy can't avoid bronchopleural fistula.Cases of pneumonectomy with right side, transfusion, incomplete resection,perioperative blood loss (>495ml) are prone to bronchopleural fistula. Coverageof stumps for these cases with expected higher risk to bronchopleural fistulashould be mandatory. The best effort should be made not to leave any canceroustissue at the end of operation, even positive lymph node.
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