[Right Completion Pneumonectomy Following Open Window Thoracostomy for Postoperative Bronchopleural Fistula].

Abstract

A 66-year-old man developed a bronchopleural fistula on postoperative day nine following video-assisted thoracoscopic right middle and lower lobectomy for right lower lobe lung cancer. An open window thoracostomy was performed on postoperative day 19. The fistula measured approximately 1 cm in diameter, and to achieve reliable closure, a right completion pneumonectomy was performed on postoperative day 56. Intraoperatively, the pleural cavity was covered with thickened granulation tissue, making anatomical identification difficult. Given the presence of infection, the procedure carried a high risk of complications such as bleeding and recurrence of bronchopleural fistula. To ensure safety, proximal vascular control was secured, and the bronchial stump was covered with an omental flap. During a three-year postoperative follow-up, no recurrence or complications were observed. Completion pneumonectomy following open window thoracostomy is extremely rare and carries high risk, thus requiring thorough preoperative planning and intraoperative preventive strategies.