Parenchyma-Sparing Bronchial Sleeve Resections in Trauma, Benign and Malign Diseases

Abstract

Objective: We evaluated our experience with parenchyma-sparing bronchial sleeve resections in trauma, benign and malign disease to determine the operative morbidity, mortality and long-term outcome. Methods: We retrospectively reviewed our prospective database of all patients who underwent bronchial sleeve resection without parenchymal loss. Clinical data, morbidity, mortality and survival were analyzed. Results: From January 1999 through December 2008, 19 patients (11 male) underwent bronchial sleeve resection without removal of pulmonary parenchyma. Median age was 42.2 ± 12.2 years (range 18 to 70 years). Indications were carcinoid tumors (n = 14), adenoid cystic carcinoma (n = 1), non-small cell lung cancer (n = 1), blunt chest trauma (n = 2) and stenosis (n = 1). Isolated resection of the bifurcation (n = 4), resection of the bifurcation en bloc with the right main bronchus with reconstruction of a “neo-trifurcation” (n = 1), resection of the right main stem bronchus (n = 6), resection of the bronchus intermedius (n = 2) and resection of the middle lobe bronchus (n = 1) were right-sided procedures. Left-sided procedures included resection of the left main stem bronchus (n = 3) and left main stem bronchus resection en bloc with the upper lobe and lower lobe bronchus (n = 2). Follow-up was complete and ranged from 11 to 108 months (median follow-up 62.7 ± 28.6 months). Morbidity was 26.4 %. The cure was delayed in 1 out of 19 anastomoses. No anastomotic dehiscence was seen. No mortality occurred. Resections were complete except for the resection of the adenoid cystic carcinoma (n = 1, R1 resection). No anastomotic stenosis or recurrence of cancer occurred in the late outcome. Conclusions: In properly selected patients, traumatic bronchial ruptures, localized malign or benign disease can be safely resected without parenchymal loss. Excellent morbidity and mortality rates and a good long-term outcome can be achieved.

sleeve resection - adenoid cystic carcinoma - carcinoid - chest trauma - parenchyma‐sparing resection

References

• 1 Thomas C P. Conservative resection of the bronchial tree.  J R Coll Surg Edinb. 1956;  3 168-186
• 2 Barclay R S, McSwan N, Welsch T M. Tracheal reconstruction without the use of grafts.  Thorax. 1957;  12 (3) 177-180
• 3 Miller Jr J I. Complications of pulmonary surgery: preoperative evaluation.  Chest Surg Clin N Am. 1992;  2 701-711
• 4 Schirren J, Muley T, Vogt-Moykopf I. Sleeve lobectomy. Shields TW, LoCicero III J, Ponn RB General thoracic surgery. 5th ed. Philadelphia, Pennsylvania; Lippincott, Williams & Wilkins 1999: 399-410
• 5 Travis W D, Brambilla E, Müller-Hermelink H, Harris C. Pathology and genetics of tumors of the lung, pleura, thymus, and heart: WHO classification of tumors. New York; Oxford University Press USA 2004: 59-62
• 6 Mountain C F. Revisions in the international systems for staging lung cancer.  Chest. 1997;  111 1710-1717
• 7 Harpole Jr D H, Feldman J M, Buchanan S, Young W G, Wolfe W G. Bronchial carcinoid tumors: a retrospective analysis of 126 patients.  Ann Thorac Surg. 1992;  54 50-54
• 8 Schreurs A J, Westermann C J, Bosch J M, Vanderschueren R G, Riviere A, Knaepen P J. A twenty-five-year follow-up of ninety-three resected typical carcinoid tumors of the lung.  J Thorac Cardiovasc Surg. 1992;  104 1470-1475
• 9 Dusmet M E, McKneally M F. Pulmonary and thymic carcinoid tumors.  World J Surg. 1996;  20 (2) 189-195
• 10 Weissberg D. Bronchial gland tumours. Pearson FG, Deslauriers J, Ginsberg RJ, Hiebert CA, McKneally MF, Urschel HC Thoracic surgery. 1st ed. Edinburgh; Churchill Livingstone 1995: 623-636
• 11 Pairolero P C, Trastek V F, Payne W S, Bernatz P E. Carcinoid tumors of the lung. Martini N, Vogt-Moykopf I Thoracic surgery: frontiers and uncommon neoplasms. St Louis, MO; Mosby Company 1989: 258-262
• 12 Kiser A C, O'Brien S M, Detterbeck F C. Blunt tracheobronchial injuries: treatment and outcomes.  Ann Thorac Surg. 2001;  71 2059-2065
• 13 Mitchell J D, Mathisen D J, Wright C D, Wain J C, Donahue D M, Moncure A C, Grillo H C. Clinical experience with carinal resection.  J Thorac Cardiovasc Surg. 1999;  117 39
• 14 Porhanov V A, Poliakov I S, Selvaschuk A P, Grechishkin A I, Sitnik S D, Nikolaev I F, Efimtsev J P, Marchenko L G. Indications and results of sleeve carinal resection.  Eur J Cardiothorac Surg. 2002;  22 685
• 15 Macchiarini P, Altmayer M, Go T, Walles T, Schulze K, Wildfang I, Haverich A, Hardin M. Hannover Interdisciplinary Intrathoracic Tumor Task Force Group . Technical innovations of carinal resection for non small-cell lung cancer.  Ann Thorac Surg. 2006;  82 1989-1997
• 16 Pearson F G, Todd T R J, Cooper J D. Experience with primary neoplasms of the trachea and carina.  J Thorac Cardiovasc Surg. 1984;  88 511-518