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Inhalation with Tobramycin^® to improve healing of tracheobronchial reconstruction

Thoracic Surgery, Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Cologne, Germany

Received 15 May 2008; received in revised form 17 December 2008; accepted 20 December 2008.

^_* Corresponding author. Address: Lungenklinik Merheim, Kliniken der Stadt Köln gGmbH, Ostmerheimerstr. 200, 51058 Köln, Germany. Tel.: +49 221 89078640; fax: +49 221 89073533. (Email: ludwigc{at}kliniken-koeln.de).

Objective: Sleeve resections were introduced to preserve lung function in patients with limited pulmonary reserve. Ischaemia and infection of the distal part of the anastomosis is the leading cause of bronchial anastomotic leakage. We have learned from our experience in lung transplantation that inhalation with Tobramycin^® helps prevent anastomotic insufficiency. We would like to present our experience in patients with tracheobronchial sleeve and prophylactic Tobramycin^® inhalation. Patients and methods: Retrospective analysis of 114 patient records, between 01.01.2005 and 31.12.2006, where a bronchial anastomosis (patients with tracheal resection were excluded) was performed. All patients received Tobramycin^® inhalation (2 x 80 mg) for 7 days. Data analysed were; length of chest tube drainage in days, complications, morbidity and hospital mortality. Results: In 694 patients, an anatomic resection was performed. Of these, 114 (16%) were sleeve resections and 63 (9%) pneumonectomies. In 21 women and 93 men, between 25 and 84 years old, sleeve lobectomy was performed 104 times and carinal resection 10 times. A preoperative neoadjuvant therapy had been given in 26%. Radical (R0) resection was possible in 94%. The duration of the operation was between 83 and 225 min (median: 127 min). Chest tubes were removed on average after 6 days. Patients were discharged after 11 days. The rate of bronchial anastomotic leakage was 4.4%. There were two patients with postoperative respiratory insufficiency and mechanical ventilation, two patients with technical failure required early correction of the suture and one patient with a necrosis of the anastomosis. Thirty-day hospital mortality was 2.6% (3/114). Conclusions: Increasing experience with sleeve resection has reduced the rate of pneumonectomy below 10%, although a number of the patients had received neoadjuvant therapy and the carinal resection rate of necrosis and infection of the anastomosis was low. We therefore recommend use of local antibiotic inhalation after sleeve resection.

Key Words: Lung cancer surgery • Nebulised antibiotics • Sleeve resection