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Persistent alveolar air leak (PAAL) after major lung resection remains a common complication in thoracic surgery. The aim of this study was to identify a subset of patients with high risk of developing PAAL after pulmonary lobectomy. Another objective was to evaluate the influence of PAAL on postoperative complications and length of hospital stay. A retrospective analysis on 895 patients undergoing pulmonary lobectomy from January 2014 to December 2019 was performed. PAAL was defined as air leak lasting more than 5 days after lung surgery. Univariate analyses and logistic regressions were performed to identify the predictors of PAAL. A backward selection algorithm was used to identify the optimal set of predictors. The incidence of PAAL was 8.2% (74/895). Male gender (p=0.017), BMI (p<0.001), transient ischemic attack (p=0.031), FEV1 (p=0.018), lobectomy combined with adjacent subsegmentectomy (p=0.018), partial and extended pleural adhesions (p=0.033 and p=0.038, respectively) were identified as independent risk factors for PAAL through logistic regression. A weak positive correlation was found between video-assisted thoracic surgery (VATS) and PAAL following pulmonary lobectomy (p=0.100). PAAL was found to be associated with higher risk of postoperative morbidity (p=0.002) and with longer hospital stay (p<0.001). Both preoperative and intraoperative risk factors may be responsible for PAAL after pulmonary lobectomy. VATS does not appear to prevent this postoperative complication. An alveolar air leak lasting beyond 5 days after pulmonary lobectomy is associated with worse postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background Variations in pulmonary venous anatomy should not be undermined by thoracic surgeons during procedures which involve the pulmonary veins. Methods We have identified vascular anomalies in 25 of 346 patients undergoing video-assisted thoracoscopic surgery lobectomy at our Thoracic Surgery Unit, between December 2016 and November 2018. Results Some vascular anomalies described have not been reported in recent literature and include right V7 draining into the middle lobe pulmonary vein, accessory right V6 behind the bronchus intermedius, two V6 from the apical segment of left lower lobe, two V6 from the apical segment of right lower lobe, and one of them draining into the superior pulmonary vein. Conclusion Thoracic surgeons should be aware of this type of anomalies because failure in the preoperative or intraoperative identification of the pulmonary venous variations may lead to serious complications. [ABSTRACT FROM AUTHOR]

Perivascular fibrosis is technically one of the most challenging issue to manage during thoracoscopic lobectomy and it is associated with increased risk of hemorrhagic injury. Here we report a case of thoracoscopic right lower lobectomy performed with individual dissection of segmental arteries due to dense adventitial fibrosis around the right lower lobe pulmonary artery. This approach may be considered as an alternative to the so-called "en masse" lobectomy and a way to avoid conversion to thoracotomy. [ABSTRACT FROM AUTHOR]

Variations in pulmonary venous anatomy should not be underestimated by thoracic surgeons prior to or during major lung resections in order to avoid serious surgical complications. Here, we report a case of middle lobe vein draining into a right inferior lobar vein formed by two anomalous trunks lying on the superior surface of the common basal bronchus: in such instance, to avoid compromising the middle lobe vein drainage during a thoracoscopic right lower lobectomy, the two main tributaries of the lower lobe vein were individually identified and dissected peripherally from the anterior aspect after division of the major fissure. A careful hilar dissection and a precise surgical strategy can help surgeons perform correct procedures in presence of pulmonary vascular anomalies. [ABSTRACT FROM AUTHOR]