Right Upper Lobe Sleeve Resection

Abstract

Bronchoscopy shows endobronchial involvement, and preoperative biopsies are performed to confirm the histology of the lesion and to determine the local extent of disease. The most common malignancy requiring sleeve resection is squamous cell carcinoma; however, sleeve resection may also be performed in patients with endobronchial adenoid cystic carcinoma, carcinoids, or bronchial adenomas. The bronchoscopic appearance that is most amenable to sleeve resection is a tumor emanating from a segmental orifice (apical, posterior, or anterior), with extension into the right main bronchus that would preclude standard lobectomy. Involvement of the right main bronchus with tumor usually requires pneumonectomy. Biopsy of the adjacent bronchial mucosa is performed to assess the extent of mucosal extension. Preoperative pulmonary function testing is considered in determining the extent of resection. In most patients with endobronchial lesions in the right upper lobe, the obstructed lobe contributes little to pulmonary function and sleeve resection results in minimal loss of pulmonary reserve. Pulmonary function testing remains important in predicting complications and is essential in considering whether a pneumonectomy would be tolerated. Quantitative ventilation and perfusion scans may be required to assess the expected loss of pulmonary function after resection in patients with proximal endobronchial lesions.