Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan

Shunsuke Endo, Norihiko Ikeda, Takashi Kondo, Jun Nakajima, Haruhiko Kondo, Yoshihisa Shimada, Masami Sato, Shinichi Toyooka, Yoshinori Okada, Yukio Sato, Ichiro Yoshino, Morihito Okada, Meinoshin Okumura, Masayuki Chida, Eriko Fukuchi, Hiroaki Miyata

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Background: Broncho-pleural fistula (BPF) and respiratory failure (RF) are life-threatening complications after lung cancer surgery and can result in long-term hospitalization and decreased quality of life. Risk assessments for BPF and RF in addition to mortality and major morbidities are indispensable in surgical decision-making and perioperative care. Methods: The characteristics and operative data of 80,095 patients who had undergone lung cancer surgery were derived from the 2014 and 2015 National Clinical Database (NCD) of Japan datasets. After excluding 1501 patients, risk models were developed from these data and validated by another dataset for 42,352 patients derived from the 2016 NCD dataset. Receiver operating characteristic curves were generated for postoperative BPF and RF development. The concordance-index was used to assess the discriminatory ability and validity of the model. Results: BPF and RF occurred in 259 (0.3%) and 420 patients (0.5%), respectively, in the model development dataset and in 129 (0.3%) and 198 patients (0.5%), respectively, in the model validation dataset. Characteristic variables including types of surgery and comorbidities were identified as risk factors for BPF and RF, respectively. The concordance indexes of assessments for BPF and RF were 0.847 (p < 0.001) and 0.848 (p < 0.001), respectively, for the development dataset and 0.850 (p < 0.001) and 0.844 (p < 0.001), respectively, for the validation dataset. Conclusions: These models are satisfactory for predicting BPF and RF after lung cancer surgery in Japan and could guide preoperative assessment and optimal measures for preventing BPF and RF.

Original languageEnglish
Pages (from-to)297-305
Number of pages9
JournalGeneral thoracic and cardiovascular surgery
Issue number3
Publication statusPublished - 2019 Mar 11


  • Broncho-pleural fistula
  • Lung cancer surgery
  • Nationwide survey
  • Respiratory failure
  • Risk assessment

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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