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THE FATE OF THE POSTRESECTION SPACE. S.Ramghulam le Roux Institute of Thoracic Surgery 2012. ‘ As nature abhors a vacuum, so does the thoracic surgeon abhor a residual space after resecting lung tissue’. Arthur W Silver. The fate of the post-resection space. Annals of Thoracic Surgery 1966. - PowerPoint PPT Presentation
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THE FATE OF THE POSTRESECTION SPACE
S.Ramghulamle Roux Institute of Thoracic Surgery 2012
‘ As nature abhors a vacuum, so does the thoracic surgeon abhor a residual space after resecting
lung tissue’
Arthur W Silver. The fate of the post-resection space. Annals of Thoracic Surgery 1966
POINTS TO UNRAVEL
What operative factors result in a space?
With what concerns should these spaces be viewed?
Hazards to the patient?
How vigorous should one be?
Terminology
Benignclosed benign space
with alveolar seepagewith bronchopleural fistula
Malignantlarger / increasing size
contain fluid symptomatic
Institutional Review
All lung resections done at one of our operative centres, IALCH between March 2010 – February 2012
Exclusion criteriapneumonectomy
lung biopsy
Methods
Retrospective analysis of clinical data and radiographs
Space considered significant ifpresent > 7 days
size arbitary
Indications for surgery
Space complications and intervention
Data analysis
158 lung resections on 157 patients
90 – inflammatory, majority sequelar / active TB
49 – malignant18 – miscellaneous
PAVM, hydatid, foregut duplication,foreign body bronchiectasis
69 pneumonectomy (excluded from analysis)89 lobectomy
Results
Significant space 14/89 (15.7%)Infected 4/14 (28 %) *
Infected spaces2 emergency for massive haemoptysis1 elective for recurrent minor haemoptysis1 post middle lobectomy for foregut duplication
cyst *
Results
Pathology
Extent of resection
Pathology
PATHOLOGY N = 89
POST
OPERATIVE SPACES
FLUID COLLECTION
Inflammatory
( sequelar / active TB )
54 ( 61 % ) 12 3 empyema
Neoplastic 26 ( 29 % ) 1 Serous effusion
Misc. 9 ( 10 % ) 1 1 empyema
EXTENT OF RESECTION
right upper 22
middle 4
lower 11
bi-lobe 7
left upper 25
lower 18
Total 87
Results
Lobectomy 80/89 (90 %)space problems 12/80 (15 %)
Bi-lobectomy 7/89 (7.9 %)space problems 2/7
(28.5%)
Segmentectomy 2/89 (2.2%)no space complications
Results
Spontaneous resolution 9/14 (65%)
Intervention 5/14 (35%)4 tube drainage
1 re-operation
Active TB with massive haemoptysisRight upper lobectomyConservative treatment
Active TB with massive haemoptysisRight upper and middle lobectomyTreated with tube drainage
6 week follow up
Follow up
Space persisting > 7 days regarded as significant
10/14 persistent spaces
8/10 complete resolution by 2/521/10 complete resolution by 3/521/10 defaulted follow up
Discussion
Empyema2 LUL
UL and ML- emergency for massive haemoptysis
1 RUL- elective minor haemoptysis – Bioglue!
1 ML - foregut duplication cyst
3/4 pathology – TB3/4 resolved1/4 required completion pneumonectomy
Discussion
Factorspathology
shrunken vs. non-shrunkeninflammatory
techniquefissures
air-leaks
parenchymal
bronchiolar
BPF
Intervention
Infection
BPF
Increase (relative)
Discussion
Discussion
Intervention
Methodsaspiration
tube drainagethoracoplastyre-operation
“The benign nature of post-operative pleural spaces is thus apparent, and it is strongly urged that aggressive treatment of these spaces be withheld unless some urgent indication, such as infection, occurs.”
Conclusion
Arthur W Silver. The fate of the post-resection space. Annals of Thoracic Surgery 1966
