Right Upper Lobe Sleeve Resection

Abstract

The first plastic-reconstructive procedures of the airway were performed after traumatic injury and tuberculous bronchostenosis.' The success of these early procedures led to the first bronchial sleeve resection for adenoma2 and c a r c i n ~ m a , ~ ? ~ during 1951 through 1952. Sleeve lobectomy was considered an alternative to pneumonectomy in patients with bronchogenic carcinoma because it preserved lung tissue and improved the quality of postoperative survival. Recent long-term studies of patients with lung carcinoma suggest that the results of sleeve lobectomy are comparable to the expected survival after standard lobectomy or pneumonectomy. Weisel et a15 reported no difference in the actuarial survival of 70 patients undergoing sleeve lobectomy compared with 70 patients undergoing pneumonectomy for stage I or I1 disease. Firmin et a16 showed that sleeve resection of squamous cell carcinoma of the upper lobe, in the absence of nodal metastases, produced a 5-year survival of 71%. In a series of 52 patients with T2NO or T3NO squamous cell carcinoma, sleeve lobectomy produced 5and 10-year survival rates of 59% and 47%.7 In a series of 101 sleeve lobectomies for stage I through stage I11 disease, RushPresbyterian-St. Luke's Medical Center reported overall 5-year survival rates of 30% to 33%.839 The right upper lobectomy is the most common sleeve resection. Surveys in Japan have shown that upper-lobe sleeve resections represent 87% of all sleeve lobectomies performed.I0 Because of the relative length of the bronchus intermedius and the favorable arterial anatomy, right upper-sleeve lobectomies are performed more than twice as frequently as left upper-sleeve lobectomies. lo A review of several published patient series support these findings with 76% of the sleeve lobectomies being performed for cancers of the right upper l 0 b e . ~ 1 ~ J ~ J ~