PULMONARY-ARTERY SLEEVE RESECTION FOR ABUTTING LEFT UPPER LOBE LESIONS

Because the left upper lobe bronchus overlies the left pulmonary arter y (PA), T2-3 lesions, N0-1 disease, or rarely inflammation may involve this vessel, necessitating lobectomy with partial PA resection or pne umonectomy with sacrifice of the lower lobe. In 486 operations perform ed for left upper lobe lesions between 1966 and 1992 (wedge, 111; segm entectomy, 131; lobectomy, 155; pneumonectomy, 89), isolated PA encroa chment was caused by bronchogenic carcinoma (32), invasive aspergillos is (2), or organized pneumonitis (1) and occurred in 9% (32/360) of ma lignant left upper lobe tumors and 2% (3/126) of benign lesions. Initi ally (1966 through 1979), PA involvement was the indication for 30% (1 8/60) of left pneumonectomies. Later (1980 through 1990), tangential r esection of the PA was attempted in 11, 5 ending up with pneumonectomy . Overall, 35 of 244 patients undergoing major left upper lobe resecti on (lobectomy or pneumonectomy) had PA encroachment. Recently, we have performed, selectively in patients with restricted lung function, six left upper lobectomies with sleeve resection of the PA. Paneled saphe nous vein interposition was used (3) or 18-mm polytetrafluoroethylene tube prostheses (3). All patients survived, 1 later requiring completi on pneumonectomy for bronchostenosis after wedge bronchoplasty. Two ha ve since died of metastases or pulmonary insufficiency; the remainder (average follow-up, 17 months) are asymptomatic with lower lobe functi on in 3 confirmed by differential ventilation-perfusion scans and pulm onary angiography.