31 - Extended Resections for Lung Cancer: Bronchovascular Sleeve Resections

Abstract

Bronchovascular sleeve resection is an indispensable technique for thoracic surgeons. This technique is performed to preserve the patient’s lung function and quality of life after surgical procedures; thus, special care must be taken to avoid postsurgical morbidity and mortality. Previous reports suggested that the incidence rates of bronchopleural fistula and surgical mortality after sleeve lobectomy and sleeve pneumonectomy were 3% and 2.5%, and 5.5% and 20.9%, respectively. In the tissue-healing process of the anastomotic site after bronchial sleeve resection, previous reports suggested that the blood flow in the bronchial arteries proximal to the anastomosis comes from the aorta, but the blood flow distal to the anastomosis comes from the pulmonary artery. There are controversies in techniques of bronchial sleeve resections regarding suturing methods, suturing layers, types of anastomosis, types of sleeve resection, and the necessity of wrapping the anastomosis. There are controversies in techniques of pulmonary artery angioplasty regarding types of resection, types of reconstruction, order of reconstruction in a double sleeve resection, and the necessity of anticoagulant therapy.