P3.16-038 Experience of 180 Bronchial Sleeve Resections for Malignant Tumors

Abstract

Sleeve lobectomy can expand the indications to radical organ-saving operations and avoiding pneumonectomy increase the number of operated ones, and also significantly improve the quality of life and rehabilitation conditions of patients, which is of special importance for persons with limited functional reserves. One surgical team performed 180 bronchial sleeve resections for malignant neoplasms of the lung. In all cases an invagination technique was used to form an anastomosis per 1 cartilage semicircle. There were 168 (93,3%) patients with primary tumors and 12 (6,7%) with solid metastatic lesions. Non-small cell lung cancer (NSCLC) was performed in 149 (88.7%) cases, carcinoid tumors - in 19 (11.3%) cases. Ia stage was diagnosed in 7.4%, Ib stage in 6.7%, IIa in 25.5%, IIb in 16.1%, IIIa in 37.6% and IIIb - 6.7% of cases. There were 80.6% (145) males and 19.4% (35) females. The average age of patients was 56.9 (from 18 to 82 years). 21 variants of bronchoplastic reconstructions was performed, lobectomy - in145 (80,6%) patients, bilobectomy – in 24 (13,3%), segmentectomy – in 6 (3,3%), isolated resection of bronchus – in 5 (2,8%) patients. In common 63 (35%) bronchoangioplasty interventions were performed. Resection of the pulmonary artery was performed in 49 cases (40 - circular, 9 - edge), vena cava resection - in 9 patients (6 - circular, 3 - edge), segmental arteries were resected in 5 patients (3 - circular, 2 - edge). In all cases of NSCLC extended ipsilateral mediastinal lymph node dissection was performed. Complications were noted in 35 patients (19.4%): pneumonia (6.1%), atelectasis of the lobe (0.6%), insufficiency of bronchial sutures (3.9%), granulation stenosis of bronchial anastomosis (1.1 %), PE (1.7%), chylothorax (1.1%), recurrent nerve paresis (1.1%), cardiac rhythm disturbances (1.7%), hemothorax (1.7%), AMI (0.6%). Postoperative mortality was in 3.9% cases. The cause of death in 3 patients was massive PE, in 1 - AMI, in 3 - failure of bronchial sutures. Long-term results were obtained in 128 patients. The one-year observed survival rate in patients after reconstructive resections was 90.6%, 3-year - 57.4%, 5-year - 42.4% (with median 48.8 months). One-year recurrence-free survival was 89.1%, 3-year - 63.8%, 5-year - 51.6% Median relapse-free survival was 55.2 months. Using the invagination technique for the bronchial anastomoses is characterized by the simplicity of technical execution and is accompanied by satisfactory immediate and long-term results.