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J Thorac Cardiovasc Surg 2000;119:939-945
© 2000 The American Association for Thoracic Surgery

General Thoracic Surgery

Effects of preoperative chemotherapy and radiation therapy on human bronchial blood flow

From the Division of Pulmonary Surgery, Osaka City Medical Hospital, Osaka, Japan.

Address for reprints: Ryoji Yamamoto, MD, Division of Pulmonary Surgery, Osaka City Medical Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka 534-0004, Japan.

Objective: We investigated the relationship between bronchial mucosal blood flow around the area of lung resection and the state of healing of the bronchial stump in patients after chemotherapy with or without radiation therapy.
Methods: Ninety patients with primary lung cancer were divided into the following 3 groups: group A, 72 patients who had no preoperative therapy; group B, 10 patients who had chemotherapy; and group C, 8 patients who had chemoradiation (60 Gy) therapy. Bronchial mucosal blood flow was measured preoperatively, intraoperatively, and postoperatively (days 8-10) with a laser Doppler flowmeter.
Results: In groups A and B bronchial mucosal blood flow was preserved sufficiently around the surgical site, and the healing of the bronchial stump was satisfactory. On the contrary, preoperative blood flow in group C was 70% of the preoperative value in group A and decreased further intraoperatively. Healing of the bronchial stump was poor, and a bronchopleural fistula occurred in one patient of group C.
Conclusion: Preoperative chemoradiation therapy may adversely affect bronchial mucosal blood flow and healing of the bronchial stump, although lymphadenectomy and preoperative chemotherapy had little effect. It is recommended that the bronchial stump should be covered with pedicled viable tissue after chemoradiation therapy for prophylaxis against bronchial complications.

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