Bronchopleural fistula following sleeve resection for bronchial adenoid cystic carcinoma—a case report

BACKGROUND: Tracheobronchial adenoid cystic carcinoma (ACC) is a rare malignant airway tumor characterized by slow growth but marked submucosal extension, which often makes complete resection difficult. When repeated positive margins are encountered intraoperatively, the surgeon must balance oncologic radicality against preservation of lung function and the safety of airway reconstruction. Postoperative bronchopleural fistula (BPF) is an uncommon but potentially life-threatening complication after bronchial reconstruction. CASE PRESENTATION: A 33-year-old female was admitted with a chief complaint ofpersistent cough with hemoptysis and a tracheobronchial mass identified 1 year earlier, with symptom aggravation over the preceding three months. Fiberoptic bronchoscopy performed at an outside hospital revealed a mass arising from the bronchial wall. After excluding surgical contraindications at our institution, the patient underwent da Vinci robot-assisted right intermediate bronchial sleeve resection. Intraoperative frozen sections repeatedly demonstrated positive bronchial margins, and a function-preserving R1 sleeve resection was ultimately performed. On postoperative day 18, the patient developed a bronchopleural fistula at the anastomotic site, which was successfully managed with Chest tube drainage alone, resulting in significant symptom relief. At 5-month follow-up, the patient remained asymptomatic, with no radiological or bronchoscopic evidence of tumor recurrence or persistent fistula. CONCLUSIONS: This case illustrates two key decision points in the management of tracheobronchial ACC. First, when R0 resection is anatomically difficult, function-preserving R1 sleeve resection followed by planned adjuvant radiotherapy may represent a reasonable alternative to pneumonectomy in selected patients. Second, postoperative anastomotic BPF does not invariably require endoscopic or surgical intervention; in carefully selected patients with a small fistula, adequate pleural drainage, preserved lung re-expansion, and no uncontrolled infection, conservative management can be effective.