Author of

• 10912

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  P1.17 - Poster Session 1 - Bronchoscopy, Endoscopy (ID 182)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Pulmonology + Endoscopy/Pulmonary
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10915

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    P1.17-003 - Endobronchial valve treatment for pulmonary air leak after anatomical resection for cancer. (ID 1125)

    09:30 - 16:30  |  Author(s): J. Yserbyt
    • Abstract

    Background
    Around 50,000 patients undergo each year a surgical resection for early stage lung cancer in the United States. Their median hospital stay after a lobectomy is 4-7 days. The European Society of Thoracic Surgery database shows that the percentage of pulmonary air leak present on day 5 is 6.8% for segmentectomy and 8.3% for lobectomy. This postoperative pulmonary expiratory air leak is usually managed conservatively. However, this is independently associated with prolonged hospital length of stay, decreased patient satisfaction, increased morbidity or postoperative complications. The use of endobronchial valves is a minimal invasive method that may be effective for the treatment of such a persistent postoperative pulmonary air leak.

    Methods
    In a prospective study, the efficacy of endobronchial valve treatment in 10 patients with a prolonged persistent pulmonary air leak after anatomic surgical resection for cancer was investigated. The primary study endpoint is the clinical efficacy on air leak cessation assessed using a digital thoracic drainage system and allowing chest tube removal. Other evaluations included avoidance of Heimlich valve, avoidance of additional surgical intervention, safety issues including complications related to endobronchial valve treatment, evaluation of consequences of airway closure on pulmonary function, and timing of endobronchial valve removal.

    Results
    Of all included patients, 90% was scheduled for valve treatment. We demonstrated air leak cessation at a median of 2 days after endobronchial valve placement, which resulted in chest tube removal at a median of 4 days after valve placement. Three patients were discharged with a Heimlich valve despite a significant reduction of their air leak after valve implantation. No single patient required additional surgical intervention. No deaths or implant-related events (such as infection distal to the endobronchial valve, hemoptysis, persistent cough, pneumothorax or expectoration of a valve) did occur. A significant decrease in FEV1 was found at airway closure by valve implantation, as compared to the functional status after valve removal (mean FEV1 53% versus 61% of predicted; p=0.0002). A 5-10% decrease in FEV1 was observed in patients when a right upper lobe was treated with endobronchial valves, while a 10-15% decrease in FEV1 was observed when a lower lobe was treated with endobronchial valves. Elective removal of the endobronchial valves was safely performed at a median of 23 days (range 14-28) after valve implantation.

    Conclusion
    Endobronchial valve treatment is an effective therapy for patients with a prolonged pulmonary air leak after anatomic resection for cancer. The aid of a digital thoracic drainage system is required as it guides endobronchial valve placement and allows a safe fast-tracking chest tube removal.