ORGAN-PRESERVING RESECTION METHODS ON LUNG-TUMORS

Resections in benign and malign lung diseases have to be carried out s paring parenchyma maximally, in order to preserve the patient's respir atory functional reserves as much as possible. In malignancies, comple te surgical remission, how-ever, must be guaranteed in the first place . Remarkedly, local recurrence of bronchial carcinoma occurs in 19% of cases after segmental resections, both anatomic and atypical, versus 4% after lobectomy in stage I, the 30-day lethality being 1% versus 5% , Where pneumonectomy can be avoided, bronchial sleeve resections are typically required. They are classically indicated on tumor involvemen t of the origin of the upper lobe bronchus, both with and without lymp h node metastasis (stages II-IIIA at the right, I-II at the left). In 30% of the cases, bronchial sleeve resections are performed in combina tion with segmental resection of the associated pulmonary artery. Ther e is a Nide variety of standardized techniques both at the bronchi and the vessels. 5-Year survival rates after sleeve resections are 52% in stage I, 42% in stage II, 18% in stage IIIA, which corresponds with t he survival rates after standard surgery. 30-day lethality is 7.6% aft er all sleeve procedures. The typical early complications resulting fr om bronchial insufficiency occur in 9.4% of cases, which might be redu ced by the use of modern absorbable monofilament. Vascular complicatio ns, on the other hand, are very rare. Cicatricial stenoses occur as la te complications. In the surgery of pulmonary metastases from various primaries, atypical segmental or wedge resect ions are the procedures used mast frequently (69%). For parenchyma-sparing resections of metas tatic lesions, too, sleeve resections both al the bronchial and the va scular tree are carried out, with the same techniques, variations and early/late complications as in bronchial carcinoma. The frequently use d median approach is not adequate for bronchoplasty procedures on the left lung.