LUNG RESECTION AFTER HIGH-DOSES OF MEDIASTINAL RADIOTHERAPY (60 GRAYSOR MORE) - REINFORCEMENT OF BRONCHIAL HEALING WITH THORACIC MUSCLE FLAPS IN 9 CASES

Mediastinal radiotherapy of more than 60 Gy highly compromises bronchi al and wound healing after lung resection. Nine patients with primary lung cancers underwent radical resection after high radiation doses. E ight patients had primary lung cancer previously treated by radiothera py alone (n = 2) or associated with chemotherapy (n = 6). One patient had a tracheal cancer involving the carina that was previously treated by radiotherapy. Seven patients underwent pneumonectomy and one patie nt underwent lobectomy with reinforcement of bronchial stump closure w ith use of the serratus anterior muscle. One patient underwent a sleev e lobectomy with bronchial reconstruction wrapped with an intercostal pedicle flap. Five patients had no postoperative complications and fou r patients had empyema, one associated with a small bronchial fistula. All except one patient were successfully treated by thoracectomy and immediate or secondary transposition of the pectoralis major muscle an d the omentum to fill the cavity. These results show that lung resecti ons can be done after high doses of radiotherapy without a high rate o f bronchial fistula by using thoracic muscle flaps to reinforce bronch ial stumps and anastomoses. In this procedure, surgical dissection is more time-consuming and increases the postoperative empyema rate (4/9) . However, the higher long-term survival may justify this choice in se lected cases.