Experiences of broncho-pleural fistula after pulmonary resection in minimally invasive approach and open thoracotomy

Background: The pulmonary resection approach has become more minimally invasive over the years. Broncho-pleural fistula (BPF), which is a serious complication that requires emergency surgical intervention, may occur even in minimally invasive approach (MIA). This study aimed to investigate the occurrence of BPF in MIA and to compare the occurrence of BPF with open chest surgery. Methods: This retrospective study included 680 cases of pulmonary resection excluding wedge resection including primary lung cancer, metastatic lung cancer and benign diseases under multi-port video-assisted thoracoscopic surgery (M- VATS), robot-assisted thoracoscopic surgery (RATS), uniportal video-assisted surgery (U-VATS) and open thoracotomy. This study investigated the causative diseases, the surgical technique, approach, and presence or absence of BPF. Patients resulted in BPF were verified the cause from background. Results: BPF occurred in 8 cases, but only 2 were in the MIA group. The BPF incidence by resection was 0.18% for lobectomy, 0.8% for segmentectomy, and 41.7% for pneumonectomy, whereas 0.29% for M-VATS, 0% for U-VATS, and 2.3% for RATS by surgical approach. The most reported diseases were benign at 4.5%, followed by metastatic lung cancer at 1.6% and lung cancer at 0.87%. The most common procedure was pneumonectomy despite covering of bronchial stump, but there was no case in lower lobectomy. There was no significant in the frequency of BPF between MIA and open thoracotomy except the cases of pneumonectomy. No deaths due to complications of BPF were experienced. Conclusions: The most at risk of BPF was pneumonectomy and it was considered there was no difference in the frequency of BPF between MIA and open thoracotomy. However, the incidence rate of BPF was low in MIA, it is possible that BPF may occur regardless of approach and procedure.