<p>Bronchopleural fistula (BPF) is a serious postoperative complication following pneumonectomy for non-small cell lung cancer (NSCLC), significantly impacting morbidity and mortality. This study aimed to compare the clinical outcomes of carinal sleeve resection and primary suturing techniques in the surgical management of BPF, with a focus on complication rates, early mortality, and long-term survival. This retrospective study analyzed 33 patients who developed BPF after pneumonectomy for NSCLC between 2019 and 2024 at our institution. Patients were divided into two groups according to the surgical intervention employed: Group A (carinal sleeve resection) and Group B (primary suturing). Postoperative morbidity, 30-day mortality, re-fistulization rates, and long-term survival were assessed. The median length of hospital stay was significantly shorter in Group A (<i>p</i> = 0.016), and 30-day mortality was also lower in this group (<i>p</i> = 0.035). Group B exhibited a higher rate of re-fistulization (<i>p</i> = 0.024). No significant difference was observed between the two groups in terms of 5-year overall survival (<i>p</i> = 0.606). Carinal sleeve resection may offer a favorable alternative in selected patients with BPF, with reduced early mortality and shorter hospitalization. While long-term survival was comparable between techniques, individualized surgical planning based on patient-specific factors remains essential.</p>