Pulmonary function and postoperative complications after wedge and flap reconstructions of the main bronchus

Tracheal or bronchial wedge resection: Case report

Background

Primary tracheal or bronchial tumors are relatively uncommon, whether benign or malignant. Sleeve resection is an excellent surgical technique for most primary tracheal or bronchial tumors. However, depending on the size and location of the tumor, thoracoscopic wedge resection of trachea or bronchus can be performed with the assistance of a fiberoptic bronchoscope for some malignant and benign tumors.

Case Description

We performed a single incision video-assisted bronchial wedge resection in a patient with a left main bronchial hamartoma with a size of 7 × 5 × 5 mm. The patient was discharged from the hospital six days after the surgery with no postoperative complications. There was no obvious discomfort during the 6-month postoperative follow-up, and the reexamination of fiberoptic bronchoscopy revealed no evident stenosis of the incision.

Conclusions

Through the detailed case study and literature review, we believe that tracheal or bronchial wedge resection is a significantly superior technique under the appropriate conditions. Video-assisted thoracoscopic wedge resection of trachea or bronchus should be a new and excellent development direction of minimally invasive bronchial surgery.

Prognostic analysis of the bronchoplastic and broncho-arterioplastic lobectomy of non-small cell lung cancers-10-year experiences of 161 patients

BACKGROUND

Bronchoplastic and broncho-arterioplastic lobectomy is technically demanding. Present study performed a prognostic analysis of lobectomy patient based on 10-year data in a high-volume center.

METHODS

Overall, 161 non-small cell lung cancer (NSCLC) cases underwent bronchoplastic and broncho-arterioplastic lobectomy between January 2004 and November 2013. Follow-up information was obtained for 88.8% patients. Prognostic analysis was performed with the Cox proportional hazards model.

RESULTS

There were 133 bronchoplastic and 28 broncho-arterioplastic procedures. In detail, 97 sleeve and 64 wedge broncho-resection and reconstructions were conducted; pulmonary artery sleeve reconstructions were performed in 26 cases and tangential resection in 135 cases. 90-day post-operative mortality was 3.1% (5/161), and 24.8% (40/161) patients had post-operative complications. 5-year overall survival was 53.4% and 5-year disease-free survival (DFS) was 48.2% for the entire case series; these survival rates were 67.7% and 55.7% for stage I (n=31), 64.4% and 58.9% for stage II (n=62), and 36.9% and 31.9% for stage III disease, respectively. Univariate analysis revealed that age >65 and higher grade of pN were associated with worse overall survival while right side tumor, non-squamous histology type, and higher grade of pT and pN were associated with worse DFS. Multivariate analysis revealed that pN is the only independent factor of worse outcome.

CONCLUSIONS

Bronchoplastic and broncho-arterioplastic lobectomy are safe procedures for indicated NSCLC patients associated with a low rate of post-operative complications but favorable long-term survival. Recognition of prognostic factors helps improve outcomes for these patients.

INITIAL EXPERIENCE OF THORACOSCOPIC LOBECTOMY PERFORMANCE WITH BRONCHOPLASTY

The article presents an initial Russian experience of video-thoracoscopic bronchoplastic lobectomies performed in 2 clinical cases of centric lung tumors. The upper bronchoplastic lobectomies with right lymphodissection were carried out on two patients in 2012. Complications weren’t observed in intraoperative and postoperative periods. There wasn’t relapse during two years after operation. Thus, the authors came to conclusion that thoracoscopic bronchoplastic lobectomies turned out to be safe and effective interventions in individual patients with centric tumor location, which wasn’t extended outside mouth of the lobar bronchus. The choice of candidates for thoracoscopic bronchoplasty was made using video-bronchoscopy, angio-computer tomography of the thorax and PET. This allowed avoiding an invasive staging and excluded patients with substantial extra-bronchial lesions.

Bronchoscopic debulking followed by bronchoplastic procedure helps in limiting lung resection in a bronchial carcinoid: a case report

Bronchoplasty is a conservative procedure in lung surgeries used in the past for patients with poor functional status but recently these procedures have been performed in low grade malignant tumors of lung avoiding extensive morbid procedure like pneumonectomy without compromising the oncologic outcome. We describe a case of bronchial carcinoid treated by bronchoscopic intervention followed by wedge bronchoplasty. The importance of bronchoscopic debulking of the tumor for accurate assessment of its extent has been highlighted. A parenchyma preserving pulmonary resection can then be performed with bronchoplastic technique, thus avoiding pneumonectomy.

[Isolated bronchial resection for tumor]

Tumors that are confined to specific areas of the airway (e.g. left main stem bronchus or the bronchus intermedius) can be removed with resections of the bronchus only and preservation of the parenchyma. During the period of January 2004 to February 2009 five patients underwent isolated bronchial resection for lung tumor with curative intent. In this study we analyzed the data of five men with a median age of 47.6 years (range 29–68 years). In four cases resection of the intermediate bronchus was performed, and in one case left main bronchus was removed. Intraoperative frozen section revealed negative bronchial resection margins in all cases. Four patients had carcinoid tumors, while one was diagnosed with chemodectoma. Minor postoperative complications were observed in two patients only. Isolated bronchial resection for lung tumor is associated with low morbidity and mortality. Lung sparing procedures are preferable in the above cases but sufficient experience and conditions are mandatory to achieve adequate results.

Sleeve and wedge parenchyma-sparing bronchial resections in low-grade neoplasms of the bronchial airway

OBJECTIVE

Sleeve and wedge bronchial resections without parenchymal resection may represent a surgical option in selected cases of low-grade neoplasms of the airway. We reviewed our experience analyzing the indications, the operative technique, and the results of such operations.

METHODS

From 1980 to 2006, we performed 248 bronchoplastic procedures, and 26 of those were bronchoplastic procedures without parenchymal resection for low-grade neoplasms of the airway. There were 17 men and 9 women with a mean age of 49.4 years (range 19-74 years). All patients underwent a preoperative bronchoscopic study, which gave indication for such a procedure, and an intraoperative bronchoscopic examination confirming the feasibility and the good quality of the bronchial suture. The bronchial resection involved the trachea and the carina (n = 5), the main bronchi (n = 7), the intermediate bronchus (n = 2), the bronchial corner (n = 6), and the lobar bronchus (n = 6).

RESULTS

The resection margins were always tumor free. There was no operative mortality. The mean hospital stay was 6.7 days (range 4-16 days). One minimal dehiscence and no stenosis of the anastomosis were observed. In 1 case we experienced a granulation that required an endoscopic treatment. The histologic type was carcinoid (n = 18), mucoepidermoid (n = 2), adenoid cystic (n = 1), chondroma (n = 2), hamartoma (n = 1), melanoma endobronchial metastasis (n = 1), and glomic tumor (n = 1). The mean follow-up was 134 months and no local relapse occurred.

CONCLUSION

Bronchoplastic procedures without resection of the lung parenchyma are a suitable and fascinating technique for selected cases of low-grade endobronchial neoplasms.

Bronchoplastic procedures in malignant and nonmalignant disease: multivariable analysis of 144 cases

OBJECTIVES

We sought to analyze the experience with bronchoplastic procedures over a 7-year period and to determine putative prognostic factors for survival.

METHODS

From 1991 to 1997, 144 bronchoplastic procedures were performed for non-small cell lung cancer (n = 123), small cell lung cancer (n = 5), carcinoid tumor (n = 10), and metastases of extrathoracic malignant tumors (n = 6). There were 111 sleeve lobectomies, 17 bilobectomies, 4 lobectomies with carinal resection, 8 sleeve pneumonectomies, and 4 bronchotomies without parenchymal resection. Multivariable analysis included risk factors, such as age, sex, type of bronchoplastic procedure (bronchotomy, lobectomy, bilobectomy, or pneumonectomy), additional angioplasty, TNM staging, histology, radicality of resection, respiratory risk (forced expiratory volume in 1 second, percent predicted < 60), cardiovascular risk, and adjuvant therapy.

RESULTS

Overall 1- and 3-year survival was 72% and 52%, respectively. The overall 30-day mortality was 8.3% (5.4% for single sleeve lobectomies). Multivariable analysis demonstrated 4 risk factors for survival. High tumor stage, type of bronchoplastic procedure, impaired lung function, and presence of cardiovascular risk were associated with a poor outcome. Univariate analysis showed reduced survival in patients with sleeve pneumonectomies (1-year survival, 25%).

CONCLUSIONS

Bronchoplastic procedures for central tumors and sleeve pneumonectomies are associated with poor survival. Careful selection of these patients, as well as of patients with impaired lung function and cardiovascular risk factors, is mandatory.

How different surgical methods of performing right upper lobectomy contribute to postoperative bronchial branching deformity: an experimental study

It has been suggested that postoperative bronchial deformity is a complication of surgery and that the surgical methods employed may play a role in its development. We studied the relationship between postoperative bronchial branching deformity and various surgical methods, including hand suturing or mechanical stapling of right upper (RU) lobectomy, versus wedge or sleeve bronchoplasty with RU lobectomy. We used an in situ bronchial casting model in rabbits and measured the branching angles between: the trachea and the right main bronchus (RMB); the trachea and the left main bronchus; the RMB and the intermediate bronchus (IB); the IB and the right middle lobe bronchus (RMLB); and the RMLB and the coronal plane. In the mechanical stapling group, the angle between the RMB and the IB was wider than in the hand suturing group, and the RMLB diverged more laterally. In the wedge plasty group, the angle between the trachea and the RMB was wider, while that between the IB and the RMLB was narrower than in the hand suturing group. In the sleeve plasty group, the angle between the RMB and the IB and that between the IB and the RMLB were wider than in the hand suturing group. The findings of this experiment clearly demonstrate that postoperative deformity of the distal bronchus varies according to the surgical methods used.