What to Know Before Bronchial Cyst Surgery
Surgery for bronchial cysts should be considered for all suspected cases in operable candidates, as asymptomatic patients often develop symptoms over time and complications may be more common when surgery is delayed until symptoms appear. 1
Pre-Surgical Preparation
Fasting Requirements
- Fast from solid foods for 4 hours before surgery 2
- Clear fluids may be consumed up to 2 hours before the procedure 2
- Longer fasting periods may be required for patients with delayed gastric emptying 3
Medical Evaluation
- A multidisciplinary assessment is essential, including:
- Evaluation by a bronchiectasis/respiratory specialist
- Thoracic surgeon assessment
- Anesthesia consultation 2
- Pre-surgical safety assessment should define:
- Expected amount of residual lung
- Underlying cardiopulmonary reserve
- Anticipated overall risks 2
Optimization Before Surgery
- Consider pulmonary rehabilitation before surgical referral 2
- Optimize nutritional status 2
- Asthmatic patients should receive bronchodilator premedication 2
- If on anticoagulants:
- Stop oral anticoagulants at least 3 days before surgery or reverse with low-dose vitamin K
- If anticoagulation must continue, reduce INR to <2.5 and start heparin 2
Laboratory Tests
- Check platelet count, prothrombin time, and partial thromboplastin time before the procedure 2
- Routine checks are only required in patients with known risk factors 2
Surgical Approach
Types of Procedures
- Video-assisted thoracoscopic surgery (VATS) is often preferred as it:
- Be aware there is a 9-12% intraoperative conversion rate from VATS to open surgery, particularly in symptomatic patients 2, 4
- Resection options include segmentectomy, lobectomy, or pneumonectomy depending on the extent of disease 2
Potential Complications
Intraoperative Complications
- Tracheobronchial tears
- Vascular injuries
- Esophageal lacerations 5
- More common in symptomatic patients (20% vs 4%) 4
Post-operative Complications
- Early morbidity rates range from 13% to 24% 2
- Common complications include:
- Mortality rates are low (0-1.4%) 2
Post-Surgical Care
Immediate Post-operative Period
- Chest radiograph should be performed at least 1 hour after surgery to exclude pneumothorax 2
- Oxygen supplementation may be required, particularly in patients with impaired lung function 2
- Continuous multi-modal physiological monitoring should be maintained 2
Recovery Instructions
- If sedated, do not drive, sign legally binding documents, or operate machinery for 24 hours 2
- Verbal and written advice should be provided about the possibility of developing a pneumothorax after leaving the hospital 2
Expected Outcomes
Success Rates
- Complete alleviation of symptoms occurs in approximately 71.5% of patients 2
- Reduction of symptoms occurs in about 20.2% of patients 2
- Freedom from symptoms has been reported as high as 61-84% when followed for 1-5 years post-operatively 2
Factors Affecting Outcomes
- Complete resection is associated with significantly better long-term outcomes 2
- Unfavorable prognostic factors include:
- Immunocompromised status
- Persistent infection with P. aeruginosa
- Extent of residual bronchiectasis 2
Important Considerations
Timing of Surgery
- Early surgical intervention is recommended even for asymptomatic bronchial cysts 5, 4
- Delaying surgery until symptoms develop may lead to:
- More difficult surgery
- Higher complication rates
- Potentially serious complications 6
- There is a small risk of malignancy developing within bronchogenic cysts, which justifies early intervention 6
Remember that while surgery carries risks, the benefits of removing bronchial cysts before complications develop generally outweigh these risks for most operable candidates.