Bronchial mucosal ablation for bronchial stump closure in right pneumonectomy: a case report

Our plain-English summary of Bronchial mucosal ablation for bronchial stump closure in right pneumonectomy: a case report, by K. Makidono, Y. Miyata, T. Ikeda, et al (Journal of Medical Case Reports, 2021).

The study

• Authors: K. Makidono, Y. Miyata, T. Ikeda, Y. Tsutani, Y. Kai, K. Kushitani, Y. Takeshima, M. Okada
• Journal: Journal of Medical Case Reports
• Published: 2021;15(1):71
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Bronchial fistula is a severe complication of pneumonectomy with a high mortality rate. We previously reported a technique for bronchial closure to prevent bronchial fistula in a canine model. We described that mucosal ablation could result in primary wound healing and involve mucosal tight adhesions histologically. In this paper, the pathologic findings of one patient, who underwent autopsy 4 years after surgery, were reviewed.

Case Presentation: A 70-year-old Japanese man was diagnosed with malignant pleural mesothelioma and underwent right extra-pleural pneumonectomy. The right main bronchus was cut using a scalpel. When closing the bronchial stump, the bronchial mucosa was ablated by electric cautery and sutured manually using 3-0 absorbable sutures. The bronchial fistula was not found after pneumonectomy. Four years after surgery, the patient died of recurrent malignant pleural mesothelioma and underwent autopsy. Macroscopic evaluation showed tight adhesions and white scars on the bronchial stump. Microscopic findings showed few inflammatory cells and α-smooth muscle actin (α-SMA)-positive cells.

Conclusions: The results from this case suggested that bronchial mucosal ablation leads to robust agglutination of bronchial stump over years. This technique is not only simple but also reliable to prevent bronchial fistula.

In plain English

This case report from Hiroshima University, Japan, described a surgical technique for closing the airway after lung removal. The article does not mention asbestos. A 70-year-old Japanese man diagnosed with malignant pleural mesothelioma had three courses of induction chemotherapy and then a right extra-pleural pneumonectomy. After the right main bronchus was cut, the surgeons burned (ablated) a 1 mm wide strip of the lining of the bronchial stump with electrocautery. They then closed the stump by hand with absorbable sutures. No bronchial fistula, a severe complication of pneumonectomy, developed after the operation. Four years later the man died of recurrent malignant pleural mesothelioma, and an autopsy was performed. The stump showed tight adhesions and white scars. Under the microscope there were fewer inflammatory cells around the adhesion, except in the innermost layer of the sutured lining, and fewer alpha-smooth muscle actin-positive cells. The authors concluded that this case suggested the ablation leads to robust closure of the stump over years. They said further studies with more clinical cases are required to confirm their findings.

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 (single patient, with autopsy findings 4 years after surgery)
• Who was studied: One 70-year-old Japanese man diagnosed with malignant pleural mesothelioma, treated at Hiroshima University
• Exposure: No asbestos or other exposure history is reported. The article concerns a surgical technique: electrocautery ablation of the bronchial stump lining (1 mm width) before manual suturing during right extra-pleural pneumonectomy, performed after three courses of induction chemotherapy
• Main results:
  • No bronchial fistula developed after the operation in this patient
  • The patient died of recurrent malignant pleural mesothelioma four years after surgery and underwent autopsy
  • At autopsy, the main bronchial stump and the intervals between stitches showed tight adhesions and white scars
  • Under the microscope there were fewer inflammatory cells around the tight adhesion, except in the innermost layer of the sutured lining, and fewer alpha-smooth muscle actin-positive cells in the adhesion area
• The authors' conclusion: The authors concluded that the results from this case suggested that bronchial mucosal ablation leads to robust closure (agglutination) of the bronchial stump over years. They described it as a potentially beneficial technique for mucosal adhesion.
• Limitations the authors state:
  • Further studies with a higher number of clinical cases are required to confirm the findings
  • The inside of the bronchial stump in this patient could not be observed after the operation

Topics

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

Medical terms in this study, explained in our Lexicon: Pneumonectomy, Autopsy, Pleural Mesothelioma, Bronchus.

Related studies

• Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy — J. Turtiainen, J.V. Räsänen, et al. (2016)
• Use of the posterior pericardium to cover the bronchial stump after right extrapleural pneumonectomy — M. de Perrot (2013)
• Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant — N. Kondo, M. Hashimoto, et al. (2020)
• Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy — G. Stamatis, G. Martini, et al. (1996)
• Digital quantification of air leak to identify the location of an alveolopleural fistula — T.M. Saettele, C.A. Jimenez (2014)
• 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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