Long-term follow up and comparison between conservative and interventional therapy in postoperative bronchopleural fistula-a cohort study

Abstract

Background: Bronchopleural fistula (BPF) is a relatively rare postoperative complication with high mortality. The management is tough and controversial. The aim of this study was to compare the short and long-term outcomes between the conservative and the interventional therapy in postoperative BPF. We also concluded our own strategy and experience of treatment in postoperative BPF.

Methods: Postoperative BPF patients with malignancies, aged from 18 to 80 years old who had undergone thoracic surgery between June 2011 and June 2020, were included in this study and followed up from 20 months to 10 years. They were retrospectively reviewed and analyzed.

Results: Ninety-two BPF patients were included in this study, 39 of whom underwent interventional treatment. Significant differences were found in the 28-day and the 90-day survival rates between the conservative and the interventional therapy (P=0.001, 43.40% vs. 76.92%; P=0.006, 35.85% vs. 66.67%). Simple conservative therapy was independently associated with 90-day mortality between the groups in postoperative BPF [P=0.002, hazards ratio (HR) =2.913, 95% confidence interval (CI): 1.480-5.731].

Conclusions: Postoperative BPF is notorious for its high mortality. Surgical and bronchoscopic interventions are recommendable in postoperative BPF as they guarantee better short and long-term outcomes compared with the conservative therapy.

Keywords: Bronchopleural fistula (BPF); conservative therapy; interventional therapy; long-term follow up.

Figure 1

Kaplan-Meier curve for 28-day survival outcome of postoperative BPF between conservative and interventional treatment (N=92, survival rate for conservative and interventional treatment are 43.40% and 76.92%). BPF, bronchopleural fistula.

Figure 2

Kaplan-Meier curve for 90-day survival outcome of postoperative BPF between conservative and interventional treatment (N=92, survival rate for conservative and interventional treatment are 35.85% and 66.67%). BPF, bronchopleural fistula.

Figure 3

Kaplan-Meier curve for 5-year survival outcome of postoperative BPF between conservative and interventional treatment (N=92, survival rate for conservative and interventional treatment are 5.66% and 0%). BPF, bronchopleural fistula.