Upper sleeve lobectomy for lung cancer with tracheal bronchus.

Abstract

with an incidence ranging from 0.1% to 2%.3,4 The term is used to designate any bronchus originating from the trachea above the level of the main carina. Tracheal bronchus is a normal finding in sheep, swine, cattle, camels, goats, and giraffes The incidence of lung cancer with bronchial anomaly is rare. Only a few cases of surgical resection for lung cancer with tracheal bronchus have been reported in the literature.1,2 We report a case of right upper sleeve lobectomy for lung cancer with tracheal bronchus. Clinical summary. A 61-year-old man with a history of pneumonia in infancy had a linear shadow on chest x-ray films. Bronchoscopic examination revealed a bronchial anomaly of the right upper bronchus; the first branch to the right upper lobe originated from the distal trachea (tracheal bronchus), and the second branch originated from the distal right main bronchus (Fig 1). Fluoroscopy with forceps insertion showed that the first branch corresponded to B1+3 and the second to B2. The orifice of B2 showed mucosal irregularity and swelling. Brush cytology at the orifice revealed squamous cell carcinoma. Systemic screening, including computed tomography of the brain and abdomen and bone scanning, showed no apparent distant metastases. Pulmonary angiography showed no abnormality. The patient underwent right upper lobectomy with lymph node dissection through right posterolateral incision. Bronchi were initially divided at the origin of tracheal bronchus, the right main bronchus distal to the bifurcation of the tracheal bronchus, and the bronchus intermedius distal to B2 with the intent of anastomosing the bronchus intermedius with the right main bronchus. The frozen section showed cancer at the proximal stump of the main bronchus, and then the distal trachea and the right main bronchus were transected obliquely (Fig 2). After the stump was confirmed to be free of disease, the distal bronchus intermedius was anastomosed with obliquely divided trachea and the main bronchus with 3-0 Vicryl (Ethicon, Inc, Somerville, NJ) interrupted sutures. The tumor was 1.5 cm in diameter, and the proximal margin of the tumor was within 2 cm from the carina. Pathologic examination showed moderately differentiated squamous cell carcinoma (pT3 N0 M0). The postoperative course was uneventful. The patient is free from disease 32 months after the resection. Discussion. Tracheal bronchus is an aberrant bronchus usually originating from the right lateral wall of the trachea, UPPER SLEEVE LOBECTOMY FOR LUNG CANCER WITH TRACHEAL BRONCHUS