TRACHEOBRONCHIAL SLEEVE RESECTIONS:PERSONAL EXPERIENCE WITH 53 CASES

A. Kır, A. Kosif Mısırlıoğlu, A. Koşar, H. Yılmaz, L. Alpay, İ. İskender, A. AtasalihiSüreyyapaşa Chest Diseases and Thoracic Surgery Research and Training Hospital, 2. Thoracic Surgery Department, Istanbul

OBJECTIVE

Surgical indications Anastomosis techniques Morbidity Mortality Survival

MATERIALS & METHODS

September 1993 - January 2007 Personal experience 53 cases

38 male, 15 female. Mean age 54 (11-74)

PREOPERATIVE WORKUP

Physical examination Chest X-Ray Spirometry Cardiac evaluation Thorax CT, if necessary multislice CT FOB and/or Rigid Bronchoscopy Wholebody screening, PET/CT

ANESTHESIA MANAGEMENT

One lung ventilation

(Robertshaw)

Ventilation across the operative field

Prolonged apneic oxygenation

TIVA(Propofol)

SURGICAL TECHNIQUE

31, % 58,5

19, % 35,8

3, % 5,7

continue

single

telescopic

SURGICAL TECHNIQUE

Suture material

No covering (except one case)

Mediastinoscopy (NSCLC) 28 / 35 cases

False (-) 3 / 28 cases

F/S during surgery

22,%41,5

11,%20,8

10,%18,9

2,%3,8

1 1 1 1 1 1 1 1

0

5

10

15

20

25

Surgery

Type of Resection

Right Upper Lobectomy

Left Upper Lobectomy

Right Sleeve Pneumonectomy

Isolated Left Main BronchusResection

Isolated Intermedier BronchusResection

Right Bilobectomy İnferior

Right Middle Lobectomy

Right Bilobectomy Süperior

Left Lower Lobectomy

Carinal Resection

Right Sleeve UpperLobectomy+Middle Lobectomy

Isolated Right Main BronchusResection

POSTOPERATIVE CARE

Effective pain control

Early mobilization

Active pulmonary exercises

If necessary FOB

Postoperative Diagnosis

1, % 2

1, % 2

14, % 26

35, % 66

2, % 3,8 NSCLC

Carcinoid Tumor

Traumatic bronchialfracture

Hamartoma

Adenoid CysticCarcinoma

ADDITIONAL SURGICAL PROCEDURES

6 Angioplasty 5 Pulmonary Artery 1 SVC (reconstruction of pericardium)

1 Vascular sleeve resection

Intrapericardial right sleeve pneumonectomy

COMPLICATIONS

NO complications in 30 (%56,6) cases

4 (%7.5) prolonged air leak

3 (%5,7) atelectasia, bronchorea

2 (%3.8) pneumonia, local recurrence, stenosis

1(%1.9) perop rupture of left main bronchus, kink, empyema, pnmtx, BPF, expansion defect, ARDS

TREATMENT OF COMPLICATIONS

6 (%11.3) bronchoscopy

4 (%7,5) pneumoperitoneum

2 (%3,8) tube thoracostomy, inoperable, medical treatment

1 (%1,9) completion pneumonectomy, inf.bilobectomy , repair of fistula , br+dilatation, primary repair, follow up

SURGICAL MORTALITY

1 (%1,9) case dead in 10th postoperative day because of ARDS

FOLLOW UP

30/53 cases followed up 41 months.

21/35 cases were NSCLC.

SURVIVAL (41 months)

%80 (16/21)

Staging

13, % 37,1

10, % 28,6

5, % 14,3

2, % 5,7

2, % 5,7

2, % 5,7 1, % 2,9

T2N1

T2N0

T3NO

T2N2

T4NO

T4N1

T4N2

Bronchial Sleeve Resections Review

Author YearPatient

sComplications

(%)Technical

Complications (%)

Mortality

(%)

Survival(5 yr; %)

Kawahara 1994 112 ns 15.6 ns ns

Van Schil 1996 145 18.6 ns 4.8 46

Gaissert 1996 72 11 1.3 4 42

Rea 1997 217 12.5 ns 6.2 49

Icard 1999 110 50 4.5 2.75 39

Kutlu 1999 100 12 2 2 49*

Massard 1999 63 28.5 9.5 1.6 43

Suen 1999 77 41.3 3.8 5.2 37.5

Tronc 2000 184 14.1 3.2 1.6 52

Okada 2000 151 10 0 0 48

Lausberg 2000 81 ns 0 1.2 61.9**

Rendina 2000 145 12.4 2.7 3 37.9

Hollaus 2001 15 26.6 6.6 0 48***

Kır 2007 53 43.4 9.5 1.9 ?

* From 6 to 168 months, **2 years, ***58 months

CONCLUSION

Tracheobronchial sleeve resections can be performed safely with low morbidity and

mortality in experienced hands!