Management of the irradiated bronchus after lobectomy for XXXX .

@entity1 @entity2 @entity358 @entity282 @entity121 @entity204
BACKGROUND: Radiation effects make operative dissection difficult, impair subsequent healing, and increase morbidity. This study evaluates tissue reinforcement of the irradiated bronchus as a modality to reduce morbidity after lobectomy for @entity2 . METHODS: We retrospectively reviewed all @entity1 who had preoperative radiotherapy before lobectomy for @entity2 between May 1977 and June 2000. RESULTS: There were 56 @entity1 (33 @entity1 and 23 @entity1 ) who ranged in age from 42 to 80 years (median, 59 years). Bronchial stump reinforcement included no coverage in 24 @entity1 (42.8%), mediastinal tissue (parietal pleura, pericardial fat, or azygos vein) in 16 (28.6%), and muscle (serratus anterior) in 16 (28.6%). Median preoperative radiation dose was 4,600 cGy (range, 3,000 to 9,810 cGy) and did not differ between the groups. There were three @entity204 (13%) in the no coverage group, one (6%) in the mediastinal tissue group, and one (6%) in the muscle group (NS). Pulmonary complication rate was 67% in the no coverage group, 44% in the mediastinal group, and 25% in the muscle group (p = 0.03). Median duration of chest tube drainage was 8 days in the no coverage group, 6 days in the mediastinal group, and 5 days in the muscle group (p = 0.006). Median hospital stay was 13 days in the no coverage group, 9 days in the mediastinal group, and 7 days in the muscle group (p = 0.02). @entity1 in the muscle group had reduced hospital stay, duration of chest tube drainage, and @entity358 compared with the other two groups (p < 0.05). Subjectively, presence and magnitude of @entity282 , range of motion, and strength of the upper extremity of the muscle flap side were not different between the groups (p = NS). Follow-up was complete and ranged from 4 to 147 months (median, 17 months). CONCLUSIONS: Tissue reinforcement of the irradiated bronchus after lobectomy reduces postoperative morbidity and hospitalization. @entity121 may be preferred.
