Parenchyma-Sparing Bronchial Sleeve Resections in Trauma, Benign and Malign Diseases

Abstract

We evaluated our experience with parenchyma-sparing bronchial sleeve resections in trauma, benign and malign disease to determine the operative morbidity, mortality and long-term outcome. We retrospectively reviewed our prospective database of all patients who underwent bronchial sleeve resection without parenchymal loss. Clinical data, morbidity, mortality and survival were analyzed. From January 1999 through December 2008, 19 patients (11 male) underwent bronchial sleeve resection without removal of pulmonary parenchyma. Median age was 42.2 +/- 12.2 years (range 18 to 70 years). Indications were carcinoid tumors (n = 14), adenoid cystic carcinoma (n = 1), non-small cell lung cancer (n = 1), blunt chest trauma (n = 2) and stenosis (n = 1). Isolated resection of the bifurcation (n = 4), resection of the bifurcation en bloc with the right main bronchus with reconstruction of a "neo-trifurcation" (n = 1), resection of the right main stem bronchus (n = 6), resection of the bronchus intermedius (n = 2) and resection of the middle lobe bronchus (n = 1) were right-sided procedures. Left-sided procedures included resection of the left main stem bronchus (n = 3) and left main stem bronchus resection en bloc with the upper lobe and lower lobe bronchus (n = 2). Follow-up was complete and ranged from 11 to 108 months (median follow-up 62.7 +/- 28.6 months). Morbidity was 26.4 %. The cure was delayed in 1 out of 19 anastomoses. No anastomotic dehiscence was seen. No mortality occurred. Resections were complete except for the resection of the adenoid cystic carcinoma (n = 1, R1 resection). No anastomotic stenosis or recurrence of cancer occurred in the late outcome. In properly selected patients, traumatic bronchial ruptures, localized malign or benign disease can be safely resected without parenchymal loss. Excellent morbidity and mortality rates and a good long-term outcome can be achieved.