The Ludwig classification for assessment of bronchial anastomosis healing after sleeve lobectomies in central lung cancer patients

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.