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01-09-2016 | ORIGINAL ARTICLE

Bronchial colonization and complications after lung cancer surgery

Authors: Jelmer E. Oor, Johannes M. A. Daniels, Yvette J. Debets-Ossenkopp, Elly S. M. de Lange-de Klerk, Jan W. A. Oosterhuis, Chris Dickhoff, Koen J. Hartemink

Published in: Langenbeck's Archives of Surgery | Issue 6/2016

Abstract

Purpose

Infectious complications occur following pulmonary resections preceded or not by induction chemoradiotherapy. We aimed to investigate whether bacterial colonization of the bronchial tree at the time of surgery was associated with postoperative complications.

Patients and methods

A retrospective analysis of all patients who underwent open anatomical pulmonary resections for malignancies at a single center was performed. Demographical data of the included patients, intraoperative data, and data on the postoperative course of patients were collected. Outcome of patients with a positive intraoperative bronchial culture was compared to patients with a negative bronchial culture. Relations between the presence of potential bacterial pathogens in the bronchial tree and other possible risk factors for the development of postoperative infectious and non-infectious complications, were analyzed using uni- and multivariate analysis.

Results

Between January 2010 and January 2012, a total of 121 consecutive patients underwent open anatomical pulmonary resections for malignancy, of whom 45 were preceded by induction chemoradiotherapy and 5 by induction chemotherapy. Intraoperative bronchial cultures were taken from 58 patients (48 %). Patients with a positive bronchial culture developed significantly more infectious (88 % vs. 20 %, p < 0.001) and non-infectious complications (63 % vs. 12 %, p = 0.001). Positive intraoperative bronchial cultures showed the strongest association with the development of infectious and non-infectious postoperative complications (OR 24.8 and 12.2, respectively). After multivariate analysis, only BMI less than 20 kg/m² and the presence of a positive intraoperative bronchial culture were found to be independent risk factors for the development of infectious complications. Chemoradiotherapy was not associated with postoperative complications in the present study.

Conclusions

Bacterial colonization of the bronchial tree assessed intraoperatively, appears to be associated with higher rates of infectious and non-infectious complications after pulmonary resection. Whether early starting of appropriate antibiotics based on intraoperative-taken culture findings will reduce the infectious complication rate in a subcategory of patients needs to be investigated.

Bernard A, Ferrand L, Hagry O, et al. (2000) Identification of prognostic factors determining risk groups for lung resection. Ann Thorac Surg 70:1161–1167CrossRefPubMed

Schussler O, Alifano M, Dermine H, et al. (2006) Postoperative pneumonia after major lung resection. Am J Respir Crit Care Med 173:1161–1169CrossRefPubMed

Bernard A, Pillet M, Goudet P, et al. (1994) Antibiotic prophylaxis in pulmonary surgery. A prospective randomized double-blind trial of flash cefuroxime versus forty-eight-hour cefuroxime. J Thorac Cardiovasc Surg 107:896–900PubMed

Boldt J, Piper S, Uphus D, et al. (1999) Preoperative microbiologic screening and antibiotic prophylaxis in pulmonary resection operations. Ann Thorac Surg 68:208–211CrossRefPubMed

Ioanas M, Angrill J, Baldo X, et al. (2002) Bronchial bacterial colonization in patients with resectable lung carcinoma. Eur Respir J 19:326–332CrossRefPubMed

Monsó E, Ruiz J, Rosell A, et al. (1995) Bacterial infection in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 152:1316–1320CrossRefPubMed

Cabello H, Torres A, Celis R, et al. (1997) Bronchial bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study. Eur Respir J 10:1137–1144CrossRefPubMed

Wansbrough-Jones MH, Nelson A, New L, et al. (1991) Bronchoalveolar lavage in the prediction of post-thoracotomy chest infection. Eur J Cardiothorac Surg 5:433–434 discussion 435CrossRefPubMed

Roberts JR, Eustis C, Devore R, et al. (2001) Induction chemotherapy increases perioperative complications in patients undergoing resection for non-small cell lung cancer. Ann Thorac Surg 72:885–888CrossRefPubMed

10.

Fujita S, Katakami N, Takahashi Y, et al. (2006) Postoperative complications after induction chemoradiotherapy in patients with non-small-cell lung cancer. Eur J Cardiothorac Surg 29:896–901CrossRefPubMed

11.

Doddoli C, Thomas P, Thirion X, et al. (2001) Postoperative complications in relation with induction therapy for lung cancer. Eur J Cardiothorac Surg 20:385–390CrossRefPubMed

12.

Matsubara Y, Takeda S, Mashimo T (2005) Risk stratification for lung cancer surgery: impact of induction therapy and extended resection. Chest 128:3519–3525CrossRefPubMed

13.

Isenberg HD (1992) Clinical microbiology procedures handbook. American Society for Microbiology. ASM press, Washington D.C.

14.

(2011) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html. Accessed 7 Feb 2012

15.

Sok M, Dragas AZ, Erzen J, Jerman J (2002) Sources of pathogens causing pleuropulmonary infections after lung resection. Eur J Cardiothorac Surg 22:23–29 discussion 27-9CrossRefPubMed

16.

Yamada Y, Sekine Y, Suzuki H, et al. (2010) Trends of bacterial colonisation and the risk of postoperative pneumonia in lung cancer patients with chronic obstructive pulmonary disease. Eur J Cardiothorac Surg 37:752–757. doi:10.1016/j.ejcts.2009.05.039 CrossRefPubMed

17.

Ferguson MK, Im HK, Watson S, Johnson E, Wigfield CH, Vigneswaran WT (2014) Association of body mass index and outcomes after major lung resection. Eur J Cardiothorac Surg 45:94–99. doi:10.1093/ejcts/ezu008 CrossRef

18.

Bagan P, Berna P, De Dominicis F, et al. (2013) Nutritional status and postoperative outcome after pneumonectomy for lung cancer. Ann Thorac Surg 95:392–396. doi:10.1016/j.athoracsur.2012.06.023 CrossRefPubMed

19.

Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF (1999) Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the national VA surgical risk study. Arch Surg 134:36–42CrossRefPubMed

Title: Bronchial colonization and complications after lung cancer surgery
Authors: Jelmer E. Oor
Johannes M. A. Daniels
Yvette J. Debets-Ossenkopp
Elly S. M. de Lange-de Klerk
Jan W. A. Oosterhuis
Chris Dickhoff
Koen J. Hartemink
Publication date: 01-09-2016
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 6/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1487-z

At a glance: The STEP trials

Springer Medicine

Bronchial colonization and complications after lung cancer surgery

Abstract

Purpose

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusions

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