Reimplantation of the upper lobe bronchus after lower sleeve lobectomy or bilobectomy: long-term results. (17th January 2018)

• Record Type: Journal Article
• Authors: Maurizi, Giulio; Ciccone, Anna Maria; Vanni, Camilla; D'Andrilli, Antonio; Ibrahim, Mohsen; Andreetti, Claudio; Menna, Cecilia; Tierno, Simone M; Venuta, Federico; Rendina, Erino A
• Is Part Of: European journal of cardio-thoracic surgery. Volume 53:Number 6(2018)
• Page Start: 1180
• Page End: 1185
• Publication Date: 2018-01-17
• Subjects: Lung cancer -- Lobectomy -- Sleeve resection; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezx494
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: The advantages of a bronchial sleeve resection are well established. A clear majority of reported cases are of upper lobe sleeve resection. Reimplantation of the upper lobe bronchus after a lower sleeve lobectomy or bilobectomy (the so-called Y-sleeve resection) is infrequent. Related technical peculiarities are the main issues. We present our experience and results in this setting. METHODS: Between 1989 and 2015, we performed 28 Y-sleeve resections of the left lower lobe ( n = 18) or right middle and lower lobes ( n = 10). The lung-sparing reconstructive operation was performed for non-small-cell lung cancer in 23 cases, for bronchial carcinoid tumour in 4 cases and for a cystic adenoid carcinoma in 1 case. Anastomotic reconstruction was performed by interrupted 4-0 absorbable sutures (monofilament material). RESULTS: All the resections were complete (R0). Postoperative mortality was 3.6%. The rate of major complications was 10.7% (1 myocardial infarction, 1 anastomotic stenosis requiring dilatation and 1 anastomotic fistula). Among the 23 patients with non-small-cell lung cancer (18 men and 5 women; mean age 58 ± 12 years), 8 were Stage I, 9 were Stage II and 6 were Stage IIIa. At a mean follow-up of 46 months, the recurrence rate was 32%. There were 2 loco-regional recurrences. No endobronchial or perianastomotic recurrence occurred. The 3- and 5-year overall and disease-free survival rates of patients with non-small-cell lung cancer were 76.3% and 55.1% and 68.7% and 62.9%, respectively. CONCLUSIONS: A Y-sleeve resection with reimplantation of the upper load bronchus is a technically feasible and oncologically adequate operation.