Modern Treatments of Bronchial Fistulas

Background : Bronchial fistulas (BF) are a dangerous complication of thoracic surgery accompanied with a high mortality rate. Long-term conservative treatment of BF is ineffective, and surgery can lead to repeated complications. Although cell therapy is considered a safe and effective method for stimulating regeneration and has found its use in many fields of medicine, its application in thoracic surgery is limited. Objective : To evaluate effectiveness of a cell product (autologous platelet lysate+allogeneic fibroblasts) in enhancing BF healing and to prove its safety. Materials and methods : Our study included 91 patients from thoracic units of the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) who were divided into 2 groupes: standard therapy (34 patients) and cell therapy (57 patients). Results : In the group receiving cell therapy, BFs healed in 93% of the patients, with no death cases. In the control group, BFs healed only in 50% of the patients (59% of them, after reoperation), and the overall mortality was 35.3%. During the follow-up, no cancer progression was observed in 47.4% of the main group patients and 20.6% of the controls, proving safety of the cell product and absence of an oncogenic effect. Conclusions : Our findings indicate that the cell product is effective in tissue regeneration compared with the standard therapy. The data on its safety and effectiveness can lay the foundation for future large-scale studies to improve clinical treatment outcomes.