Chengjun Ban, Zhigang Cai, Gengye Chen, Xianliang Chen, Zhongshu Chen, Zhaozhong Cheng, Weimin Ding, Wen Dong, Yili Fu, Hong Gao, Ye Gu, Lianfu He, Zhongliang He, Weidong Hu, Yijiang Huang, Faguang Jin, Min Li, Wangping Li, Xingbin Li, Cunzhi Lin, Huihuang Lin, Huining Liu, Jiaping Liu, Jingyu Liu, Zhiguang Liu, Liping Lv, Dianzhu Pan, Zhengbu Sha, Guanle Shen, Fei Tang, Meimei Tao, Jing Wang, Wenzhang Wang, Xiaodong Wang, Xiaoping Wang, Zhina Wang, Haihong Wu, Feng Xu, Guoliang Xu, Tao Xu, Dongyong Yang, Weixia Yu, Xiaogang Zeng, Yiming Zeng, Guochao Zhang, Huaping Zhang, Nan Zhang, Xiangwu Zhang, Xiao Zhao, Changhao Zhong, Youqing Zhong, Hongmei Zhou, Yong Zhou, Heng Zou, Yuna Zu, Zhong Li, Hongwu Wang, Writing Group for the Chinese Expert Consensus on the Diagnosis and Management of Bronchopleural Fistula after Pulmonary Resection (2026 Edition)*
This consensus proposes a structured, classification-based pathway for postoperative BPF after pulmonary resection. It emphasizes early recognition, standardized localization, source control before closure, individualized bronchoscopic intervention, timely surgical escalation and uniform outcome assessment to improve cross-center comparability and support future prospective studies.
BACKGROUND: Bronchopleural fistula (BPF) after pulmonary resection is one of the most severe postoperative complications and is associated with persistent air leak, pleural contamination, empyema, contralateral lung contamination, respiratory failure and substantial resource use. Standardized, operable guidance for postoperative BPF remains limited in China, especially regarding classification, occult fistula localization, device selection and timing of bronchoscopic or surgical escalation.
METHODS: This expert consensus was developed by a multidisciplinary working group and registered in the Practice guideline REgistration for transPAREncy (PREPARE) platform (PREPARE-2026CN709). Clinical questions were generated from real-world controversies and expert discussion. Literature was searched in PubMed, Embase, Web of Science, the Cochrane Library, Wanfang and the China National Knowledge Infrastructure (CNKI) up to March 2026, supplemented by reference tracking and manual retrieval. Evidence was summarized and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework when applicable; good practice points (GPPs) were used for recommendations based mainly on clinical consensus. Three rounds of structured Delphi consultation were conducted using a 5-point Likert scale; scores of 4-5 indicated agreement, and a consensus threshold of 85% was prespecified. In Round 3, 46 experts completed confirmatory scoring of 25 items, all of which reached the prespecified consensus threshold; these items were subsequently reorganized into 29 final consensus statements.
RESULTS: Twenty-nine consensus statements were developed. The consensus defines scope and high-risk populations; recommends a three-level diagnostic framework; differentiates postoperative BPF from uncomplicated postoperative pleural effusion or pneumothorax, isolated empyema or residual-cavity infection without demonstrable airway-pleural communication; classifies postoperative BPF as central or peripheral; stratifies BPF by bronchoscopic visibility and maximum fistula diameter; emphasizes reproducible localization for occult or peripheral BPF; prioritizes drainage, pleural-space management, infection control and systemic optimization before closure; and provides type-based bronchoscopic, surgical escalation, outcome assessment and follow-up strategies.
CONCLUSIONS: This consensus proposes a structured, classification-based pathway for postoperative BPF after pulmonary resection. It emphasizes early recognition, standardized localization, source control before closure, individualized bronchoscopic intervention, timely surgical escalation and uniform outcome assessment to improve cross-center comparability and support future prospective studies.