Search Results (5)

Background/Objectives: Sleeve and wedge bronchial resections without removal of lung tissue may represent a surgical option in selected cases of low-grade neoplasms. This study is a retrospective analysis of the surgical technique and the short- and long- term results of bronchial sleeve resections performed in the Department of Thoracic Surgery of Careggi Hospital in Florence, Italy, and in the Department of Thoracic Surgery of Marie Lannelongue Hospital in Plessis Robinson, France. Methods: Between January 2017 and October 2024, 25 patients with low-grade tumors underwent bronchial sleeve resection with total lung-sparing. We collected the preoperative data, surgical techniques, postoperative results and long-term oncologic outcomes. Results: We performed 25 bronchial sleeves which resulted in 20 typical carcinoids (TC), 3 atypical carcinoids (AT) and 2 mucoepidermoid carcinomas. Three patients had R1 resection, and one of them also had N1 disease; a multidisciplinary team opted for a “watch and wait” policy without adjuvant therapies. No local recurrences occurred, although three distant recurrences were observed. The five-year overall survival (OR) rate was 100%; the five-year disease-free survival (DFS) rate was 80%. Conclusions: Bronchoplastic procedures without lung parenchyma resection are an appropriate and feasible technique for selected cases of low-grade endobronchial neoplasms. Full article

Background: Bronchial sleeve resection with complex reconstruction is a rare and intricate surgical procedure, particularly when addressing metastatic carcinoid tumors. This case report details the surgical management of a young male with a typical carcinoid tumor metastasized to the hilar and subcarinal lymph nodes. Case Presentation: A 28-year-old medically fit male presented with cough and occasional blood-tinged sputum for 2 months that was diagnosed to be due to a typical carcinoid tumor involving the left main bronchus, with metastasis to the hilar and subcarinal lymph nodes. The patient underwent a left bronchial sleeve resection with complex reconstruction of the left lower lobe bronchus. The reconstructed bronchus was then anastomosed to the main bronchus followed by hilar and subcarinal lymph nodes dissection. The surgical approach aimed to preserve lung parenchyma while ensuring complete tumor resection. Postoperative recovery was uneventful, with the patient demonstrating satisfactory respiratory function. Histopathological examination confirmed the complete resection of the carcinoid tumor and metastatic lymph nodes (hilar and inter-lobar LN (positive 2/5) and subcarinal LN (positive 1/6)). The patient had no signs of recurrence at the 3-month follow-up. Conclusions: This case highlights the feasibility and effectiveness of bronchial sleeve resection with bronchial reconstruction in managing metastatic carcinoid tumors. The successful outcome underscores the importance of meticulous surgical planning and execution in achieving favorable results in complex thoracic surgeries. Full article

Background: Standard sleeve lobectomies are recommended over pneumonectomy (PN), but the efficacy and oncological proficiency of complex sleeve lobectomies (CSLs) have not been completely investigated. The aim of this study was to report our experience in CSL in patients affected by a centrally located non-small-cell lung cancer (NSCLC), comparing all the variables and outcomes with PN. Methods: From 2014 to 2022, we collected the data of patients who underwent PN and CSL for NSCLC, excluding neuroendocrine tumors, salvage surgery or carinal resection. Regression analysis was used to assess the association between procedures and complications; the Kaplan–Meier method and Cox regression analysis were used to evaluate survival and risk factors of reduced survival. Results: We analyzed n = 38 extended sleeve lobectomies and n= 6 double-sleeve lobectomies (CSL group) and n= 60 PNs. We had a trend toward higher postoperative mortality in the PN group (5% vs. 0%, p = 0.13). Major complications and bronchial fistula developed in 21.7% and 6.8% (p = 0.038) and in 6.7% and 4.5% (p = 0.64), respectively. The right side was identified as risk factor for major complications, whereas age > 70 and PN had a trend of association in multivariable analysis. The median OS was similar between the two groups (p = 0.76) and cancer recurrence was the only significant risk factors of reduced OS. Excluding functionally compromised patients, the OS of CSL was better than that of PN (67% vs. 42%, p = 0.25). Conclusions: Considering that major complications are often associated with mortality after surgery for centrally located NSCLC, CSLs could be considered an alternative to PN while also ensuring comparable survival. Full article

Uniportal VATS has become an accepted approach in minimally invasive thoracic surgery since its first report for lobectomy in 2011. Since the initial restrictions in indications, it has been used in almost all procedures, from conventional lobectomies to sublobar resections, bronchial and vascular sleeve procedures and even tracheal and carinal resections. In addition to its use for treatment, it provides an excellent approach for suspicious solitary undiagnosed nodules after bronchoscopic or transthoracic image-guided biopsy. Uniportal VATS is also used as a surgical staging method in NSCLC due to its low invasiveness in terms of chest tube duration, hospital stay and postoperative pain. In this article, we review the evidence of uniportal VATS accuracy for NSCLC diagnosis and staging and provide technical details and recommendations for its safe performance for that purpose. Full article

Bronchial sleeve lobectomy offers a chance to avoid excessive resections such as pneumonectomy in central lung tumors. Recent technical advances enable complex procedures such as video-assisted thoracoscopic bronchial sleeve lobectomy (VABSL). We present a case of a 64-year-old patient who underwent the right upper VABSL due to adenocarcinoma. During resection the bronchus was transsected and a specimen removed due to tumor proximity. Intraoperative frozen section revealed no neoplastic infiltration in the bronchial cut line. Due to a stiff round shape of the bronchial defect, impossible to approximate by direct suturing without kinking, sleeve lobectomy was undertaken. Bronchial section was performed through utility incision partly under direct vision. End-to-end anastomosis was led with open surgery needle holder, forceps and with continuous Maxon 4–0. Postoperative stay was uncomplicated and bronchoscopy revealed wide lumen of anastomosis. Full article