Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant

Our plain-English summary of Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant, by N. Kondo, M. Hashimoto, T. Takuwa, et al (General Thoracic and Cardiovascular Surgery, 2020).

The study

• Authors: N. Kondo, M. Hashimoto, T. Takuwa, S. Matsumoto, Y. Okumura, S. Hasegawa
• Journal: General Thoracic and Cardiovascular Surgery
• Published: 2020;68(12):1562-1564
• Read it: PubMed · Publisher

Abstract

Treatment options for bronchial fistula (BF) after pneumonectomy are often limited and carry significant morbidity and mortality. The patient underwent right extrapleural pneumonectomy for malignant pleural mesothelioma had BF without macroscopic fistula found by bronchography. We treated this minor BF using bronchoscopy with the administration of OK-432, fibroblast growth factor basic, and fibrin glue sealant. Two weeks after this treatment, we confirmed the improvement of the fistula by bronchography. Bronchoscopic therapy for BF was useful for a small, early fistula without infection.

In plain English

This case report describes one patient, a 49-year-old man with malignant pleural mesothelioma. He had his right lung and surrounding pleura removed (a right extrapleural pneumonectomy) after chemotherapy given before surgery. The article does not mention asbestos exposure. On day 18 after surgery, a chest X-ray showed a loss of fluid on the right side, and an X-ray dye test of the airways (bronchography) suggested a small leak from the airway (a bronchial fistula). The patient had no fever, and blood tests did not indicate infection. Using a flexible bronchoscope passed into the airway, the doctors injected OK-432 into the airway lining, sprayed basic fibroblast growth factor on the site, and applied fibrin glue. One week later the fistula looked smaller, and they repeated the procedure. Bronchography later confirmed the fistula had improved, and the patient started chemotherapy after surgery. A chest CT scan 7 months after treatment confirmed the fistula had closed. The authors concluded that a bronchoscopic approach with appropriate agents can be an effective treatment for this kind of fistula after surgery in selected cases.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 49-year-old man with malignant pleural mesothelioma who had a right extrapleural pneumonectomy after neoadjuvant chemotherapy. The authors are from the Department of Thoracic Surgery, Hyogo College of Medicine, Japan.
• Exposure: Not reported. The article does not describe asbestos or any other exposure. The subject is a treatment: bronchoscopic OK-432 injection, basic fibroblast growth factor spray and fibrin glue for a bronchial fistula.
• Main results:
  • On postoperative day 18 the patient had a suspected bronchial fistula, was afebrile, and blood data did not indicate infection.
  • OK-432 was injected into the bronchial mucosa through a bronchoscope, followed by basic fibroblast growth factor spray and fibrin glue.
  • One week later, bronchoscopy showed the fistula had become smaller, and the procedure was repeated.
  • Bronchography confirmed improvement of the fistula, and the patient could receive postoperative chemotherapy.
  • Chest CT 7 months after the bronchoscopic treatment confirmed closure of the fistula.
• The authors' conclusion: The authors concluded that a bronchoscopic approach with appropriate agents can be an effective treatment for bronchial fistula after surgery in selected cases.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pneumonectomy, Bronchoscopy, Fibroblast, Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma.

Related studies

• Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy — G. Stamatis, G. Martini, et al. (1996)
• Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy — J. Turtiainen, J.V. Räsänen, et al. (2016)
• Digital quantification of air leak to identify the location of an alveolopleural fistula — T.M. Saettele, C.A. Jimenez (2014)
• Single site venovenous extracorporeal membrane oxygenation as an alternative to invasive ventilation in post-pneumonectomy fistula with acute respiratory failure — M. Fica, F. Suárez, et al. (2012)
• A link between the fibroblast growth factor axis and the miR-16 family reveals potential new treatment combinations in mesothelioma — K. Schelch, M.B. Kirschner, et al. (2018)
• Squamous cell carcinoma arising from the pleura after pneumonectomy for squamous cell carcinoma of the lung — M. Franke, H.D. Chung, et al. (2010)

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