Background:

Central bronchopleural fistula (cBPF) is one of the most severe complications after pulmonary resection, with high morbidity and mortality. Bronchoscopic occlusion has emerged as a minimally invasive treatment for cBPF, but systematic evidence to guide optimal material selection and to predict treatment efficacy is lacking.

Objectives:

To evaluate how anatomical characteristics of cBPF influence the choice of bronchoscopic occlusion materials, and to develop a risk model for individualized prediction of long-term occlusion outcomes.

Design:

Single-center retrospective observational study.

Methods:

We analyzed clinical data of 56 patients with postoperative cBPF. Fistula anatomical features and their matching with various occlusion materials were evaluated. Occlusion strategies were categorized as pure pharmacologic therapy, stent-only, or combined approaches, according to the actual combinations of materials used during bronchoscopic occlusion. An outcome prediction model was constructed using the least absolute shrinkage and selection operator (LASSO) for feature selection and a Bayesian cumulative logit mixed-effects model for longitudinal outcomes at multiple time points, and key risk factors for long-term outcomes were identified during follow-up.

Results:

Fistula size and type largely determined the choice of occlusion strategy. Occlusion outcomes evolved dynamically over time, with the 3-month postocclusion mark representing a key inflection point in outcome stability. The model showed that the 1–3-month period after bronchoscopic occlusion was a high-risk window for unfavorable occlusion grades. Patients with occult fistulas and those treated with pure pharmacologic therapy were more likely to maintain or regain better occlusion status. A visual risk-scoring nomogram was constructed based on this model to support risk stratification and individualized outcome prediction.

Conclusion:

This study provides new evidence to guide material selection for bronchoscopic cBPF occlusion and to predict therapeutic outcomes and long-term prognosis. The findings support an individualized treatment strategy and dynamic management approach for patients with bronchial stump fistula.

Plain language summary

Which airway-leak seal works best? Tracking long-term results after lung surgery

After lung surgery, a small number of patients develop an unwanted opening between the main airway and the space around the lung. This problem—called an airway leak or bronchopleural fistula—lets air and fluid move where they should not, causing cough, breathlessness and infection. Traditionally, surgeons had to reopen the chest to fix the leak. Today, doctors can often seal it from inside the airway with a flexible camera (a bronchoscope) and special sealing materials such as tissue glue or tiny stents. We reviewed the records of 56 patients who received this bronchoscopic treatment in one hospital. By comparing the size of each leak, the material used to seal it and the patient’s infection status, we discovered three practical lessons: Size matters. Small leaks (under 5 mm) usually healed when only a chemical “scar-forming” agent was injected. Larger leaks needed a stent or a combination of materials to stay closed. The first three months are critical. Most treatment failures happened within 1–3 months after the procedure, especially if infection in the chest cavity was still present. A simple risk score can guide follow-up. We created an easy bedside tool that combines leak size, infection markers and treatment type to predict each patient’s chance of long-term healing. These findings can help doctors choose the right sealing method, schedule closer check-ups during the high-risk early period and act sooner if healing is at risk.

Search results

Bronchoscopic occlusion for central bronchopleural fistula after pulmonary resection: material selection and risk model for long-term prognosis