Post-resectional bronchopleural fistula: aetiology, clinical management and future perspectives: a narrative review

Background and Objective: The aim of this review is to focus on post-resectional broncho-pleural fistula pathophysiology, clinical management, surgical approach and future perspectives of treatment. Bronchopleural fistula (BPF) is a pathological communication between the airways and the pleural cavity that may occur after pulmonary resection and chest traumas or following complications of thoracic infections or disruption of lung parenchyma bullae. The final scenario of defective bronchial suture healing after major pulmonary resection may result in a life-threatening ventilatory and infective disaster. Methods: This is an unsystematic narrative review of previously published information about post-operative BPF. The research was done by accessing the following databases: MEDLINE; Cochrane database of systematic reviews. Delimiting search terms were: broncho-pleural fistula; lung resection; lung cancer; operative bronchoscopy; open window thoracostomy; stem cell technology. Inclusion criteria were: papers written in English about post-resectional broncho-pleural fistula from the above-mentioned databases [2000–2023]. Key Content and Findings: this review will focus on post-resectional broncho-pleural fistula pathophysiology, clinical management, surgical approach and future perspectives of treatment. Conclusions: Although quite rare, BPF represents a life-threatening condition with a significant mortality rate; it thus still represents one of the most feared complications by thoracic surgeons. Significant independent risk factors for postoperative BPF development were right side, low preoperative albumin values, the use of EndoGIA stapler and bronchial stump diameter. In the case of BPF not amenable to minimally invasive endoscopic repair, open window thoracostomy (OWT) remains the most effective therapeutic approach. Minimally invasive endoscopic approach—in particular with stem cell local bronchoscopic application—represents a valuable and promising therapeutic option for small calibre BPF.