MAINSTEM BRONCHIAL SLEEVE RESECTION WITH PULMONARY PRESERVATION

Background. Resection of a mainstem bronchus with pulmonary preservati on is a therapeutic option when disease is limited to the mainstem bro nchus. We reviewed our experience with this procedure to determine the operative morbidity, mortality, and long-term outcome. Methods. From January 1965 through January 1995, 22 patients (13 male, 9 female) und erwent circumiferential mainstem bronchial sleeve resection without re moval of pulmonary parenchyma. Median age was 37 years (range, 12 to 7 0 years). The right mainstem bronchus was involved in 12 patients and the left, in 10. Nineteen patients (86%) were symptomatic; symptoms in cluded cough in 5, dyspnea in 5, wheeze in 3, hemoptysis in 3, and a c ombination of these in 3. Conventional tomography was done in 8 patien ts and identified every lesion. Bronchoscopy was diagnostic in all pat ients. Resection was for cancer in 15 patients (68%), benign stricture in 5 (23%), and an impacted broncholith in 2 (9%). The cancer was a c arcinoid in 9 patients, a mucoepidermoid carcinoma in 3, squamous cell carcinoma in 2, and adenoid cystic carcinoma in 1. Fourteen patients were postsurgically classified as stage IIIA (T3 N0 M0) and 1 patient as stage IIIB (T4 N2 M0). The median length of the resected bronchus w as 2.0 cm (range, 1.0 to 4.0 cm). Two patients required hilar release maneuvers. The bronchial anastomosis was reinforced with pleura in 10 patients, pericardium in 2, and serratus anterior muscle in 1. Results . There were no operative deaths. Three patients (14%) had postoperati ve complications. Follow-up was complete and ranged from 6 months to 2 5.7 years (median follow-up, 10.2 years). Twenty-one patients are curr ently alive. All patients are asymptomatic except 1 patient, who requi red a stent for an anastomotic stricture. No patient has had recurrenc e of cancer. Conclusions. In properly selected patients, mainstem bron chial sleeve resection with lung preservation can be performed safely and provides excellent relief of symptoms with good long-term survival .