# Delayed Bronchopleural Fistula Formation Following Salvage Surgery of Stage IV Anaplastic Lymphoma Kinase-Positive Non-Small-Cell Lung Cancer

## TL;DR

A patient with advanced lung cancer developed a delayed bronchopleural fistula after surgery and TKI treatment, requiring additional surgical intervention.

## Contribution

This case report documents a rare delayed complication of bronchopleural fistula following salvage surgery and TKI therapy in ALK-positive NSCLC.

## Key findings

- A delayed bronchopleural fistula occurred six weeks after salvage pulmonary resection.
- The patient required decortication, airway repair, and muscle flap coverage to treat the fistula.
- The case highlights the complexity of managing post-surgical complications in ALK-positive NSCLC patients.

## Abstract

This case report highlights the management of a delayed bronchopleural fistula (BPF) following salvage pulmonary resection to achieve local control and no radiographic evidence of disease in a patient treated with serial tyrosine kinase inhibitors (TKIs) for stage IV anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC). The initial pulmonary resection was complicated by dense adhesions and an abnormally torturous pulmonary artery. Six weeks after the index surgery, the patient presented with a delayed BPF requiring decortication, repair of airway, and coverage of the bronchial stump with a serratus anterior muscle flap.