• Bronchoplasty
• Bronchopleural fistula (BPF)
• Low-dose glucocorticoids

• Humans
• Retrospective Studies
• Male
• Female
• Glucocorticoids/administration & dosage
• Bronchial Fistula/prevention & control
• Bronchial Fistula/etiology
• Middle Aged
• Pleural Diseases/prevention & control
• Pleural Diseases/etiology
• Postoperative Complications/prevention & control
• Adult
• Serum Albumin/analysis
• ROC Curve
• Aged
• Logistic Models
• Risk Factors
• Bronchi/surgery

• NSCLC
• bronchial stump buttressing
• bronchopleural fistula
• indocyanine green fluorescence
• intercostal muscle flap
• pneumonectomy

• Humans
• Pneumonectomy/adverse effects
• Pneumonectomy/methods
• Bronchial Fistula/prevention & control
• Bronchial Fistula/etiology
• Bronchial Fistula/surgery
• Postoperative Complications/prevention & control
• Surgical Flaps
• Pleural Diseases/prevention & control
• Pleural Diseases/etiology
• Male
• Female
• Middle Aged

• Bronchopleural fistula
• Immune checkpoint inhibitors
• Immune-related adverse event
• Neoadjuvant therapy
• Non-small cell lung cancer

• Humans
• Carcinoma, Non-Small-Cell Lung/drug therapy
• Carcinoma, Non-Small-Cell Lung/surgery
• Neoadjuvant Therapy/adverse effects
• Immune Checkpoint Inhibitors
• Lung Neoplasms/drug therapy
• Lung Neoplasms/surgery
• Fistula
• Immunotherapy/adverse effects
• Postoperative Complications/etiology

• bronchopleural fistula
• complications
• lung cancer
• pneumonectomy
• thoracic surgery
• tissue flaps

• Humans
• Pneumonectomy/adverse effects
• Cohort Studies
• Bronchial Fistula/etiology
• Bronchial Fistula/prevention & control
• Bronchial Fistula/surgery
• Surgical Flaps/adverse effects
• Pleural Diseases/surgery
• Lung Neoplasms/surgery
• Lung Neoplasms/complications

Bronchopleural fistula (BPF) is a relatively rare, but severe complication of pulmonary tuberculosis. It is associated with significant mortality; however, its management remains a major therapeutic challenge.

We present a 24-year-old man with BPF resulting from severe pulmonary tuberculosis combined with mixed infections. The damaged right upper lobe and concomitant empyema were demonstrated via computed tomography. After undergoing open-window thoracostomy and tuberculosis treatment for 4 mo, decortication and right upper lobectomy were subsequently performed, leading to the resolution of tuberculosis and other concurrent pulmonary infections. Follow-up, 6 mo after surgery, failed to reveal any evidence of infection recurrence resulting in a good prognosis.

The disease course of tuberculous BPF is particularly challenging. Surgical intervention serves as an effective and safe therapeutic strategy for BPF.

• Bronchopleural fistula
• Tuberculosis
• Surgery
• Case report

Anastomosis management is the main challenge of airway resection and reconstruction, and postoperative anastomotic complications, including ischemia, stenosis, dehiscence, and separation may lead to severe outcomes and a poor prognosis. The anastomotic buttress is vital in airway reconstruction, but the selection of surgical buttress and reinforcement remains controversial. We aimed to demonstrate and evaluate the buttress options of anastomosis, including their preoperative characteristics, the intraoperative process, and the incidence of postoperative complications to help address the controversy regarding anastomosis management.

This retrospective study was conducted at a single institution. Patients who underwent airway reconstruction with anastomotic wrapping from Jan. 2019 to Sep. 2021 were enrolled in this study and preoperative characteristics and operational features were collected. All patients were carefully followed up by telephone and outpatient. Their postoperative complications and postoperative status after 6 months were recorded. The surgical procedures and clinical characteristics of the buttress options of anastomosis were assessed.

A total of 62 patients undergoing either cervical tracheal, thoracic tracheal, carinal, or secondary carinal and main bronchus resection and reconstruction were evaluated. The anastomotic buttress used included mediastinal pleural flap (24/62, 38.7%), anterior cervical muscle (14/62, 22.6%), sternocleidomastoid (2/62, 3.2%), thymus flap (12/62, 19.4%), intercostal muscle flap (2/62, 3.2%), biological patch (2/62, 3.2%), prepericardial fat (1/62, 1.6%), thyroid gland (1/62, 1.6%), pectoralis major flap (2/62, 3.2%), and omental flap (2/62, 3.2%). All procedures produced satisfactory results without short-term anastomotic complications. A follow-up for 6 months was conducted and all patients were alive postoperatively. Tracheomalacia stenosis postoperatively occurred in 3 patients and they were subsequently treated with an endotracheal stent. One patient had tumor recurrence 3 months after surgery and received adjuvant chemotherapy.

Various anastomotic wrapping materials are used in airway reconstruction. Different utilizations of buttress are selected according to the anatomic characteristics and the reconstruction method used. This study indicated that appropriate surgical buttresses for wrapping anastomoses are legitimate alternatives to reduce the risk of anastomotic complications.

• Airway reconstruction
• anastomostic wrapping
• material evaluation

• Bronchopleural fistula
• Lung cancer
• Pneumonectomy
• Risk classification

• bronchopleural fistula
• lung transplant
• mechanical ventilation
• omental flap
• pulmonary resection

• Bronchial coverage
• Computed tomography value
• Pedicle pericardial fat tissue
• Tracheobronchoplasty

• Angiogenesis
• Bronchial stump
• Bronchopleural fistula
• Cell sheet
• Fibroblast
• Tissue formation

• Bronchial Fistula/etiology
• Bronchial Fistula/prevention & control
• Bronchial Fistula/surgery
• Humans
• Pleural Diseases/etiology
• Pleural Diseases/prevention & control
• Pleural Diseases/surgery
• Pneumonectomy
• Postoperative Complications/epidemiology
• Postoperative Complications/prevention & control
• Retrospective Studies
• Surgical Flaps

Bronchial fistula is a severe complication of pneumonectomy with a high mortality rate. We previously reported a technique for bronchial closure to prevent bronchial fistula in a canine model. We described that mucosal ablation could result in primary wound healing and involve mucosal tight adhesions histologically. In this paper, the pathologic findings of one patient, who underwent autopsy 4 years after surgery, were reviewed.

A 70-year-old Japanese man was diagnosed with malignant pleural mesothelioma and underwent right extra-pleural pneumonectomy. The right main bronchus was cut using a scalpel. When closing the bronchial stump, the bronchial mucosa was ablated by electric cautery and sutured manually using 3-0 absorbable sutures. The bronchial fistula was not found after pneumonectomy. Four years after surgery, the patient died of recurrent malignant pleural mesothelioma and underwent autopsy. Macroscopic evaluation showed tight adhesions and white scars on the bronchial stump. Microscopic findings showed few inflammatory cells and α-smooth muscle actin (α-SMA)-positive cells.

The results from this case suggested that bronchial mucosal ablation leads to robust agglutination of bronchial stump over years. This technique is not only simple but also reliable to prevent bronchial fistula.

• Bronchial fistula
• Bronchial mucosal ablation
• Bronchial stump

• Neoadjuvant immunotherapy
• bronchopleural fistula (BPF)
• lobectomy
• lung cancer
• pembrolizumab
• video-assisted thoracoscopic surgery (VATS)

The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence.

This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years.

Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified.

The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.

• Bronchial fistula
• Bronchial stump
• Complication
• Flap reinforcement
• Lung resection

外科手术是目前根治非小细胞肺癌（non-small cell lung cancer, NSCLC）的最有效方式。全肺切除作为一种术式被应用于临床中。对于中央型肺癌，袖式肺叶切除术因其术后肺功能丧失少、术后并发症及死亡率低逐渐取代全肺切除术成为主流。然而为保证肿瘤学效果，当其他术式无法完全切除时，全肺切除术式仍是必要的。全肺切除术后主要发生心肺并发症，充分了解全肺切除术后相关并发症能帮助临床医师及时做出诊断，并进一步采取相关措施降低术后并发症对患者的不良影响。充分了解预后相关危险因素可帮助临床医师提前采取措施尽可能规避风险，从而改善患者预后。

• Complications
• Pneumonectomy
• Risk factors

• Bronchopleural fistula
• Complications
• Flap coverage
• Pneumonectomy
• Risk factors

The intrathoracic transposition of the omentum (ITO) has been reported with more or less good results in various clinical circumstances but with no clear guidelines or indications.

This article reviews the main clinical situations in which omento-plasty (OP) may be taken into consideration by the thoracic surgeons: mediastinitis and deep sternal infections after median sternotomy, reinforcement of the eso-gastric anastomosis after esophagectomy, prevention and treatment of the bronchial fistula after pulmonary resection, space-filling procedures for empyema, mediastinal tracheostomy, management of the infected intrathoracic vascular grafts / ventricular assist devices and heart OP. For each clinical situation we have performed a literature review with analysis of the most relevant published papers searching for an evidence-based approach for the use of the ITO/OP in thoracic surgery.

OP may be an elegant solution for a wide range of problems in thoracic surgery. In the published literature, there are mainly case-reports and relatively small series published resulting in a low level of evidence for both ITO as a surgical technique by itself, as well as for the use of OP in various clinical situations involving the chest structures. The indications for its use in thoracic surgery are based more on common sense and the lack of other solutions.

• Bronchial fistula
• Empyema
• Eso-gastric anastomosis
• Esophagectomy
• Infected vascular grafts
• Median sternotomy
• Mediastinal tracheostomy
• Mediastinitis
• Omentoplasty
• Omentum
• Space-filling procedures

• Sleeve resection
• bronchial anastomosis
• lung cancer

• Aged
• Angiography
• Aorta, Thoracic/surgery
• Aortic Aneurysm, Thoracic/complications
• Aortic Aneurysm, Thoracic/diagnostic imaging
• Aortic Aneurysm, Thoracic/surgery
• Bronchial Arteries/diagnostic imaging
• Bronchial Arteries/physiopathology
• Endovascular Procedures/methods
• Humans
• Intercostal Muscles/blood supply
• Lung Neoplasms/complications
• Lung Neoplasms/diagnostic imaging
• Lung Neoplasms/surgery
• Male
• Pneumonectomy/methods
• Radiography, Thoracic
• Regional Blood Flow
• Thoracic Arteries/diagnostic imaging
• Thoracic Arteries/physiopathology
• Tomography, X-Ray Computed
• Treatment Outcome

• Bronchial Fistula/surgery
• Bronchoscopy/instrumentation
• Female
• Humans
• Male
• Pleural Diseases/surgery
• Pneumonectomy/adverse effects
• Respiratory Tract Fistula/surgery
• Stents

Small cell lung carcinoma represents 15–20% of lung cancer. Is is characterized by rapid growth and early disseminated disease with poor outcome. For many years surgery was considered a contraindication in Small Cell Lung Cancer (SCLC) since radiotherapy and chemoradiotherapy were found to be more efficient in the management of these patients. Never the less some surgeons continue to be in favor of surgery as part of a combined modality treatment in patients with SCLC. The revaluation of the role of surgery in this group of patients is based on clinical data indicating a much better prognosis in selected patients with limited disease (T1-2, N0, M0), the high rate of local recurrence after chemoradiotherapy with surgery considered eventually more efficient in the local control of the disease and the fact that surgery is the most accurate tool to access the response to chemotherapy, identify carcinoids misdiagnosed as SCLC and treat the Non Small Cell Lung Cancer component of mixed tumors. Performing surgery for local disease SCLC requires a complete preoperative assessment to exclude the presence of nodal involvement. In stage I surgery must always be followed by adjuvant chemotherapy, while in stage II and III surgery must be planned only in the context of clinical trials and after a pathologic response to induction chemoradiotherapy has been confirmed. Prophylactic cranial irradiation should be used to reduce the incidence of brain metastasis

• Bronchi/surgery
• Bronchial Fistula/prevention & control
• Diabetes Complications/prevention & control
• Humans
• Pleural Diseases/prevention & control
• Pneumonectomy/adverse effects
• Postoperative Complications/prevention & control
• Surgical Flaps