Risk factors of middle lobe bronchus kinking following right upper lobectomy.

Content Provider	Europe PMC
Author	Yanagihara, Takahiro Sekine, Yasuharu Sugai, Kazuto Kawamura, Tomoyuki Maki, Naoki Saeki, Yusuke Kitazawa, Shinsuke Kobayashi, Naohiro Kikuchi, Shinji Goto, Yukinobu Ichimura, Hideo Sato, Yukio
Copyright Year	2021
Abstract	BackgroundThe incidence rate of kinking of the middle lobe bronchus following right upper lobectomy is higher compared to that with residual lung bronchus following other lobectomies. Bronchial kinking was presumed to be caused by the displacement of the residual lung lobes, but its etiology is unclear. Moreover, prevention methods and effective treatments have not yet been established. The purpose of this study was to investigate the risk factors and etiology of middle lobe bronchus kinking and discuss prevention methods.MethodsPatients who underwent right upper lobectomy in our hospital were retrospectively evaluated. Patient clinical characteristics, lung function, and lung lobe volume, surgical procedure were analyzed in association with the incidence of middle lobe bronchus kinking. The association between the displacement of residual lung lobes after operation and the incidence of middle lobe bronchus kinking was analyzed to assess the etiology.ResultsA total of 175 patients were enrolled in the risk analysis. Middle lobe bronchus kinking was observed in 5 patients (2.9%). The low percentage of forced expiratory volume percentage in 1 second (P=0.021), the low volume ratio of the right middle lobe (RML) to the right thoracic cavity (RTC) (P=0.016), and the low volume ratio of RML to right upper lobe (RML/RUL) (P=0.006) were significant risk factors of middle lobe bronchus kinking. In the patients who underwent CT at 6 months after surgery, the degree of the cranial displacement of RML was associated with the incidence of middle lobe bronchus kinking (P=0.025).ConclusionsThe risk of middle lobe bronchus kinking could be assessed preoperatively by calculating the volume ratio of RML/RTC and RML/RUL. The displacement of RML could be associated with the incidence of middle lobe bronchus kinking.
ISSN	20721439
Journal	Journal of Thoracic Disease
Volume Number	13
PubMed Central reference number	PMC8182536
Issue Number	5
PubMed reference number	34164192
e-ISSN	20776624
DOI	10.21037/jtd-21-105
Language	English
Publisher	AME Publishing Company
Publisher Date	2021-05-01
Access Restriction	Open
Rights License	Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0. 2021 Journal of Thoracic Disease. All rights reserved.
Subject Keyword	Bronchial kink bronchial kinking middle lobe atelectasis lung volume ratio lung volume
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine