Methods of Additional Coverage of Bronchial Sutures after Bronchoplastic Procedures for Malignant Lung Tumors

Introduction. Prevention of bronchopleural fistula after bronchoplastic procedures for malignant lung tumors remains a major challenge in thoracic oncology. As a result, the search for reliable techniques to reinforce and cover bronchial sutures continues to be clinically important.

Materials and methods. Between 2021 and 2024, 17 elective bronchoplastic procedures were performed in the onco-thoracic department of the Chelyabinsk Regional Center for Oncology and Nuclear Medicine in patients with central non-small-cell lung cancer. The cohort included 7 circular bronchoplasties, 1 circular broncho-angioplasty, 1 circular bronchoplasty with a polybronchial anastomosis, and 8 wedge bronchoplasties. Three methods of additional bronchial suture coverage were used: a vascularized intercostal muscle flap (5 patients), a pedicled pleural‑fat flap (5 patients), and a free pleural‑fat flap harvested from the pericardial region (7 patients).

Results and discussion. No bronchopleural fistulas occurred in the postoperative period. Five patients experienced exacerbation of chronic bronchitis. One patient developed prolonged air leak with subcutaneous emphysema, and one patient had intrapleural bleeding. Postoperative empyema occurred in one patient and resolved after drainage and pleural lavage. At the time of publication, 15 patients were in remission. Two patients who underwent circular bronchoplasty died 7 and 8 months postoperatively due to tumor progression.

Conclusions. Routine coverage of bronchial sutures after bronchoplastic lung resections for malignant tumors is recommended to reduce the risk of bronchopleural fistula. The choice of flap should be determined by the operating surgeon.

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