WCLC 2025 - Posters & ePosters-EP.07.04 Pathological Investigation of Bronchial Stump and Bronchopleural Fistula After Anatomical Pulmonary Resection for Lung Cancer

EP.07.04 Pathological Investigation of Bronchial Stump and Bronchopleural Fistula After Anatomical Pulmonary Resection for Lung Cancer

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This study by Arai et al. investigates the pathological and clinical features of bronchopleural fistula (BPF) following anatomical pulmonary resection for lung cancer. BPF is a serious postoperative complication with unclear physiological mechanisms and limited pathological data on natural bronchial stump healing.<br /><br />The retrospective review included 1002 lung cancer patients who underwent procedures such as lobectomy, segmentectomy, bilobectomy, and pneumonectomy between 2011 and 2021 at Kanagawa Cardiovascular and Respiratory Center. BPF developed in 6 cases (0.6%) and was significantly associated with right lower lobectomy (RLL) and presence of interstitial pneumonia (IP), with onset ranging 20-260 days post-surgery. Autopsy examinations on four patients without cancer recurrence revealed that bronchial stumps were held together firmly by surgical staples, with epithelial damage and concentric fibrosis around staple holes indicating repetitive repair from breathing movements.<br /><br />Pathologically, bronchial stump healing involves epithelial lining restoration, granulation tissue formation, fibrotic repair, and reinforcement by adjacent lung tissue to maintain stump closure. The authors propose BPF formation is influenced by both biological factors (infection, tissue damage, steroid use, hypoxia, poor circulation linked to IP and diabetes) and physical/mechanical factors (strong negative intrathoracic pressure, bronchial curvature, radiation).<br /><br />Notably, IP emerged as a key risk factor likely due to hypoxia and circulatory impairment that compromises bronchial repair, while the varied timing of BPF onset suggests mechanical stress on the bronchial stump plays a role in late complications.<br /><br />In conclusion, this study highlights that right lower lobectomy and interstitial pneumonia significantly increase BPF risk after lung cancer surgery. The pathological findings elucidate the bronchial stump healing process and how both biological and mechanical factors contribute to BPF development. Understanding these mechanisms can help guide risk assessment and preventive strategies in high-risk patients undergoing pulmonary resection.

Asset Subtitle

Hiromasa Arai

Meta Tag

Speaker Hiromasa Arai

Topic Early-Stage Non-small Cell Lung Cancer

Keywords

bronchopleural fistula

lung cancer surgery

anatomical pulmonary resection

right lower lobectomy

interstitial pneumonia

bronchial stump healing

postoperative complications

pathological features

risk factors

mechanical stress