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Case Reports
. 2020 Dec;8(24):1691.
doi: 10.21037/atm-20-7582.

Bronchopleural fistula following a video-assisted thoracoscopic surgery lobectomy after neoadjuvant therapy of pembrolizumab: a case report and literature review

Min Cao  1 , Yujie Fu  1 , Xiuying Xiao  2 , Jian Tang  1 , Daoqiang Tang  3 , Xiaojing Zhao  1
Affiliations
Case Reports

Bronchopleural fistula following a video-assisted thoracoscopic surgery lobectomy after neoadjuvant therapy of pembrolizumab: a case report and literature review

Min Cao et al. Ann Transl Med. 2020 Dec.

Abstract

Lung cancer has the highest morbidity and mortality worldwide among the malignant tumors. The treatment of lung cancer was difficult in the decade years. Currently, the advent of immune checkpoint inhibitors (ICIs) has changed the pattern of lung cancer treatment. Programmed death-ligand 1 (PD-L1) inhibitors, such as pembrolizumab, plus platinum-based chemotherapy is the preferred treatment modality for advanced or metastatic non-small cell lung cancer (NSCLC) patients. The success of pembrolizumab in lung cancer has increased interest in expanding the use of neoadjuvant treatment. Immune-related adverse events (irAEs) are the most common adverse reactions in immunotherapy. The balance between the benefits and risks is crucial in this setting. Video-assisted thoracoscopic surgery (VATS) is a routine procedure of resectable NSCLC treatment. It appears to favor low postoperative complication rate. The prolonged air leakage (PAL) is the most common complication after VATS, and the bronchopleural fistula (BPF) is the most serious complication. The management of adverse events after VATS, especially in the setting of immune therapy, need to be raised. Here, we report a case of BPF following VATS lobectomy, which firstly presented the treatment-related adverse event with neoadjuvant combination therapy of pembrolizumab plus cisplatin/pemetrexed. Literature on novel neoadjuvant immunotherapy was also reviewed in the present study.

Keywords: Neoadjuvant immunotherapy; bronchopleural fistula (BPF); lobectomy; lung cancer; pembrolizumab; video-assisted thoracoscopic surgery (VATS).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-7582). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Tumor cells’ morphology is showed by hematoxylin-eosin staining (A) Hematoxylin-eosin staining showing poorly differentiated adenocarcinoma and (B) numerous necrotic tumors after neoadjuvant immunotherapy. Original magnification ×100.
Figure 2
Figure 2
The bronchial stump is showed by bronchoscopy (A) The bronchial fistula of the right upper lobe and (B) bronchial fistula healing in the right upper lobe.
Figure 3
Figure 3
The diagram of anastomose. (A) Anastomose the right upper lobe bronchus via the fourth intercostal at the anterior axillary line and (B) anastomose via the seventh intercostal at the posterior axillary line.
See this image and copyright information in PMC

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