Clinicoradiologic Predictors of Anastomotic Complications After Bronchoplasty for Lung Cancer

We investigated the predictive factors for anastomotic complications in sleeve lobectomy for lung cancer.

Between February 2008 and April 2023, 196 patients underwent sleeve lobectomy for lung cancer; 140 were included after exclusion of those who underwent extended sleeve lobectomy and salvage surgery after definitive chemoradiotherapy. Clinicopathologic and computed tomography (CT) findings were retrospectively investigated, and predictors of anastomotic complications were analyzed. The CT finding of azygos arch invasion was defined as a compression or stenosis of the azygos arch by the tumor.

Lobectomy types were right upper lobectomy in 71 patients, right lower lobectomy in 5, left upper lobectomy in 53, and left lower lobectomy in 11. CT finding of azygos arch invasion was detected in 21 cases. Anastomotic coverage was performed in 41. Bronchial anastomotic complications were observed in 11 patients (7.9%), including 9 with an anastomotic fistula and 2 with stenosis, all of which were on the right side. Only right upper sleeve lobectomy was a significant predictor of anastomotic complications (odds ratio, 5.29; 95% CI, 1.07-26.13). In 71 cases of right upper sleeve lobectomy, anastomotic complications were significantly more frequent (33.3% vs 4.0%; P < .01) and predictive of anastomotic complications when tumor invasion into the azygos arch was detected on CT (odds ratio, 12.00; 95% CI, 2.24-64.42).

Right upper sleeve lobectomy is a predictor of anastomotic complications. Particular attention should be paid to anastomotic complications in right upper sleeve lobectomy with suspected tumor invasion of the azygos arch on CT.