Objective: To evaluate principal risk factors and different therapeutic approaches for postpneumonectomy bronchopleural fistula (BPF), focusing on open window thoracostomy (OWT). Methods: We retrospectively reviewed all patients treated by pneumonectomy for lung cancer between 1999 and 2014. We evaluated preoperative, operative, and postoperative data; interval between operation and fistula formation; and size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log-rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. A P value < .05 was considered statistically significant. Results: BPF occurred in 60 of 733 patients (8.2%). Bronchial suture with a stapler (Endo GIA; P = .02), right side (P = .003), and low preoperative albumin levels (<3.5 g/dL; P = .02) were independent predictive factors. Early BPF was treated by thoracotomic (n = 12) or thoracoscopic (n = 2) debridement of necrotic tissue and BPF surgical repair. Late BPF was treated by bronchoscopic application of fibrin glue (n = 3) or endobronchial stent (n = 1), or chest tube and cavity irrigation with povidone-iodine (n = 15). OWT was performed in 27 patients, followed by muscle flap interposition in 7 of these 27. The median survival time of patients after treatment for BPF was 29.0 months. Overall survival in the patients treated with OWT was 50% at 2 years and 27 (8%) at 4 years. Conclusions: Optimal management of BPF depends on several factors. In the event of failure of an initial therapeutic approach, OWT, followed by myoplasty, may be considered.
- Bronchopleural fistula
- Lung cancer
- Open window thoracostomy
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine