title: The Rationale for Treatment of Postresectional Bronchopleural Fistula: Analysis of 52 Patients.
abstract: BACKGROUND
  Bronchopleural fistulas are a major therapeutic challenge. We have reviewed our experience to establish the best choice of treatment.
  
  
  METHODS
  From January 2001 to December 2013, the records of 3,832 patients who underwent pulmonary anatomic resections were retrospectively reviewed.
  
  
  RESULTS
  The overall incidence of bronchopleural fistulas was 1.4% (52 of 3,832): 1.2% after lobectomy and 4.4% after pneumonectomy. Pneumonectomy vs lobectomy, right-sided vs left-sided resection, and hand-sewn closure of the stump vs stapling showed a statistically significant correlation with fistula formation. Primary bronchoscopic treatment was performed in 35 of 52 patients (67.3%) with a fistula of less than 1 cm and with a viable stump. The remaining 17 patients (32.7%) underwent primary operation. The fistula was cured with endoscopic treatment in 80% and with operative repair in 88.2%. Cure rates were 62.5% after pneumonectomy and 86.4% after lobectomy. The cure rate with endoscopic treatment was 92.3% in very small fistulas, 71.4% in small fistulas, and 80% in intermediate fistulas. The cure rate after surgical treatment was 100% in small fistulas, 75% in intermediate fistulas, and 100% in very large fistulas. Morbidity and mortality rates were 5.8% and 3.8%, respectively.
  
  
  CONCLUSIONS
  The bronchoscopic approach shows very promising results in all but the largest bronchopleural fistulas. Very small, small, and intermediate fistulas with a viable bronchial stump can be managed endoscopically, using mechanical abrasion, polidocanol sclerosing agent, and cyanoacrylate glue. Bronchoscopic treatment can be repeated, and if it fails, does not preclude subsequent successful surgical treatment.
authors.affiliation: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardillo
authors.affiliation: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy. Electronic address: luigicarb@gmail.com.
authors.forename: Luigi
authors.initials: L
authors.lastname: Carbone
authors.affiliation: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carleo
authors.affiliation: Unit of Thoracic Endoscopy, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Galluccio
authors.affiliation: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Martino
authors.affiliation: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Giunti
authors.affiliation: Unit of Thoracic Endoscopy, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lucantoni
authors.affiliation: Unit of Thoracic Endoscopy, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Battistoni
authors.affiliation: Unit of Thoracic Endoscopy, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Batzella
authors.affiliation: Unit of Thoracic Endoscopy, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Dello Iacono
authors.affiliation: Memotef Department, Sapienza University of Rome, Rome, Italy.
authors.forename: Lea
authors.initials: L
authors.lastname: Petrella
authors.affiliation: Unit of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Dusmet
mesh_terms: D001983:Bronchial Fistula / Q000601:surgery*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000601:surgery*; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000601:surgery*; D016156:Respiratory Tract Fistula / Q000601:surgery*; D012189:Retrospective Studies