Chinese expert consensus on the diagnosis and management of bronchopleural fistula after pulmonary resection (2026 edition).

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.