Khirurgiia · 2026
[The Ludwig classification for assessment of bronchial anastomosis healing after sleeve lobectomies in central lung cancer patients].
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Zhemchugova-Zelenova O A, Petrov A S, Perederiy V E, Atyukov M A, Mishcheryakov S A, Martynikhina M S, Pishchik V G, Yablonskii P K
Аннотация
OBJECTIVE: To identify the correlation between Ludwig grades of bronchial anastomosis and bronchial complications after sleeve lobectomy in central non-small cell lung cancer patients, as well as to study perioperative factors influencing bronchial anastomosis healing.
MATERIAL AND METHODS: A retrospective study included 31 patients with central non-small cell lung cancer grade I-IIIA after sleeve lobectomy. They underwent fibrobronchoscopy in 7 days and 3-6 months after surgery.
RESULTS: Patients with good anastomotic healing after 7 postoperative days (Ludwig I-II) did not have bronchial complications in 65% of cases after 6 months; 35% of these patients had mild stenosis of anastomosis (grade I-II). Among patients with Ludwig grade III-V after 7 postoperative days, we found stenosis grade I-II in 20% of cases and grade III-IV in 40% of cases. Other 40% of patients in this group had bronchopleural fistula. Unfavorable prognostic factors of poor anastomotic healing (Ludwig grade ≥ III) were difference in diameter of sutured bronchi > 37.02% (p=0.046), VAMLA 6-10 days before sleeve lobectomy (p=0.033), and no covering of bronchial anastomosis (p=0.042).
CONCLUSIONS: The Ludwig classification of bronchial anastomosis healing on postoperative day 7 is a significant tool to predict complications after sleeve lobectomy.
MATERIAL AND METHODS: A retrospective study included 31 patients with central non-small cell lung cancer grade I-IIIA after sleeve lobectomy. They underwent fibrobronchoscopy in 7 days and 3-6 months after surgery.
RESULTS: Patients with good anastomotic healing after 7 postoperative days (Ludwig I-II) did not have bronchial complications in 65% of cases after 6 months; 35% of these patients had mild stenosis of anastomosis (grade I-II). Among patients with Ludwig grade III-V after 7 postoperative days, we found stenosis grade I-II in 20% of cases and grade III-IV in 40% of cases. Other 40% of patients in this group had bronchopleural fistula. Unfavorable prognostic factors of poor anastomotic healing (Ludwig grade ≥ III) were difference in diameter of sutured bronchi > 37.02% (p=0.046), VAMLA 6-10 days before sleeve lobectomy (p=0.033), and no covering of bronchial anastomosis (p=0.042).
CONCLUSIONS: The Ludwig classification of bronchial anastomosis healing on postoperative day 7 is a significant tool to predict complications after sleeve lobectomy.