WITHDRAWN: Bronchopleural fistula after pneumonectomy: Risk factors and management, focusing on open window thoracostomy.

Abstract Objective To evaluate principal risk factors and different therapeutic approaches for postpneumonectomy bronchopleural fistula (BPF), focusing on open window thoracostomy (OWT). Methods We retrospectively reviewed all patients treated by pneumonectomy for lung cancer between 1999 and 2014. We evaluated preoperative, operative, and postoperative data; interval between operation and fistula formation; and size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log-rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. A P value  Results BPF occurred in 60 of 733 patients (8.2%). Bronchial suture with a stapler (Endo GIA; P  = .02), right side ( P  = .003), and low preoperative albumin levels ( P  = .02) were independent predictive factors. Early BPF was treated by thoracotomic (n = 12) or thoracoscopic (n = 2) debridement of necrotic tissue and BPF surgical repair. Late BPF was treated by bronchoscopic application of fibrin glue (n = 3) or endobronchial stent (n = 1), or chest tube and cavity irrigation with povidone-iodine (n = 15). OWT was performed in 27 patients, followed by muscle flap interposition in 7 of these 27. The median survival time of patients after treatment for BPF was 29.0 months. Overall survival in the patients treated with OWT was 50% at 2 years and 27 (8%) at 4 years. Conclusions Optimal management of BPF depends on several factors. In the event of failure of an initial therapeutic approach, OWT, followed by myoplasty, may be considered.