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

J Thorac Cardiov asc Surg 2007;134:373-7

ObjectiveObjective

A retrospective studies A retrospective studies represent a surgical option in selected cases of low-grade neoplasms of the airway.

Analyze the indications, the operative technique, and the results of such operations.

MethodsMethods

From 1980 to 2006, 248 bronchoplastic procedures was performed ( 26 of those were bronchoplastic procedures without parenchymal resection for low grade

neoplasms of the airway)

17 men and 9 women with a mean age

of 49.4 years (range 19-74 years).

MethodsMethods

A preoperative workup including a physical examination, a chest radiograph and computed

tomographic (CT) scan, an abdominal ultrasound, and a bronchoscopic examination with biopsy.

intraoperative bronchoscopic examination

CT with 3-dimensional reconstruction (virtual endoscopy)

preoperative laser treatment

Operative methodsOperative methods

Wedge bronchial resections were sutured with single stitches of polyglyconate 4-0 (Maxon)

Sleeve bronchial resections were performed with a continuous suture in the membranou wall and single stitches in the cartilagineous part.

Suture sites was wrapped with either pedicled pericardial fat or pleura or fibrin glue to prevent a bronchov

ascular fistula. Dissect the inferior pulmonary ligament Fill the pleural cavity with saline solution, reexpaned

the lung – check air leakage

Operative methodsOperative methods

Remove hilar and peribronchial lymph nodes , and a systematic sampling of the mediastinal nodes was performed.

Post-operation : chest CT and a bronchoscopic examination were performed every 6 months for the first 2 years and then on an annual basis.

ResultsResults

The resection margins were always tumor f

ree. There was no operative mortality. The mean hospital stay was 6.7 days (rang

e 4–16 days). One minimal dehiscence and no stenosis o

f the anastomosis were observed. In 1 case, a granulation that required an en

doscopic treatment.

Results – site of bronchoplatiesResults – site of bronchoplaties

ResultsResults

Histologic type : carcinoid (n 18), mucoepidermoid (n 2), ade

noid cystic (n 1), chondroma (n 2), hamartoma (n 1), melanoma endobronchial metastasis (n 1), and glomic tumor (n 1).

ConclusionsConclusions

Key points to perform sleeve and wedgKey points to perform sleeve and wedge parenchyma-sparing bronchial resecte parenchyma-sparing bronchial resection:ion:

● A benign or low-grade malignant bronchial lesion without extrabronchial spread

● A small basis of implant of the lesion and a normal bronchial tree at its periphery

● Absence of hilar or mediastinal nodal metastasis

ConclusionsConclusions

Intraoperative bronchoscopic guideIntraoperative bronchoscopic guide is a nec is a necessary tool to cut the bronchial wall adequaessary tool to cut the bronchial wall adequately close to the lesion.tely close to the lesion.

Tumor obstructed the lumen of respiratory Tumor obstructed the lumen of respiratory airway – obstructive pneumonia ( airway – obstructive pneumonia ( laser trealaser treatment + rigid bronchoscopetment + rigid bronchoscope))

Intraluminal bronchial tumor extended to seIntraluminal bronchial tumor extended to segmental bronchi, particularly locating in the gmental bronchi, particularly locating in the left or right upper lobes. --- difficulty to treatleft or right upper lobes. --- difficulty to treatmentment

ConclusionsConclusions

Bronchoplastic procedures without rBronchoplastic procedures without resection of lung parechymaesection of lung parechyma – adequat – adequate, fascinating technique for low-grade ee, fascinating technique for low-grade endobronchial neoplasms.ndobronchial neoplasms.

Thanks your attention! Thanks your attention!