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

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.