The Significance of Reconstructive Tracheal and Bronchial Surgery in the Context of Malignant Pulmonary Tumours

Abstract

Lung cancer holds a prominent position in the malignant mortality rates. Despite the rapid advancement of pharmacological approaches to the lung malignancy treatment, surgical interventions remain relevant and pertinent in contemporary practice. The choice of an appropriate therapy for local lung cancer presents a particularly acute dilemma. This issue gives rise to contradictions as it necessitates a tailored approach for each individual case. In such instances, the only radical treatment methods for lung cancer involve surgical interventions, namely pneumonectomy and lobectomy/bilobectomy. The preference leans towards lobectomy, given that this choice mitigates disability, thereby enhancing the patient's quality of life. Organ-preserving surgery holds a distinct significance for patients with compromised functional reserves, where complete lung resection is intolerable. However, at the time of identifying centrally located lung neoplasms, tumors or metastatic lymph nodes often extend to the orifices of the segmental and main bronchi. A lobectomy is feasible only with the resection (wedge-shaped or circumferential one) of the main bronchus and subsequent bronchoplasty. Tumor invasion of the pulmonary artery presents a formidable obstacle to organ-preserving surgery.In cases where pneumonectomy is intolerable, bronchoangioplastic lobectomy/bilobectomy stands as the sole viable radical intervention. Pneumonectomy with wedge-shaped or circumferential resection of the trachea, followed by tracheobronchoplasty, represents one of the most intricate procedures in thoracic surgery. However, when the tumor extends to the tracheal bifurcation, only this operation allows for a radical surgical approach. Notably, in circumstances where the tumor (carcinoid) affects the main bronchus, partial circumferential bronchial resection with subsequent bronchoplasty becomes feasible. Thus, the entire pulmonary ventilation capacity is preserved. Clinical observations of such procedures have been documented in patients with diminished functional reserves.