Sleeveresection for Lung Tumors of Various Etiologies. Own Experience

Abstract

Relevance. Lung cancer occupies leading positions in oncologic morbidity, but despite the successes in the development of chemotherapy and radiation therapy, surgical radical operations are in the first place in the treatment of this pathology. In operations with tumor localization in the central bronchi bronchoplastic operations are irreplaceable in the practice of oncologic surgeon.Objective to analyze our experience in performing bronchoplastic operations, to identify factors influencing the course of early postoperative period, development of complications.Materials and methods. The study is based on the results of surgical treatment of 102 patients in the period from 2018 to November 2023, who underwent organ-preserving sleeve lobectomy. The choice of the method of surgical treatment was substantiated, the immediate and long-term results were presented. Preoperative evaluation included blood tests, computed tomography (CT) of the chest, abdomen, and brain; pulmonary function tests to assess the state of the respiratory and cardiovascular systems. Videobronchoscopy with preoperative biopsy of central masses was performed in all patients. Positron emission tomography combined with CT (PET-CT), magnetic resonance imaging (MRI), skeletal bone scanning were performed as needed. All patients underwent double-lumen endotracheal intubation. The surgical access was an anterolateral thoracotomy in the fifth or sixth intercostal space. Intraoperative histologic examination of bronchial resection lines was performed in all cases. All patients underwent systematic mediastinal lymphodissection and it was performed before bronchial reconstruction.Results. 102 patients underwent bronchoplastic lobectomy for lung tumors. Concomitant pathology of varying severity was present in 79 patients (77.5 %). 73 operations (71.6 %) were performed on the right lung and 29 (28.4 %) on the left lung. Patients who underwent wedge resection of the TBT were 57 (55.9 %), with circular resection of the bronchus — 45 (44.1 %). There were no statistically significant differences by sex, age, concomitant pathology and process prevalence among the patients.Discussion. Bronchoplastic operations have a pronounced safety profile in the surgical treatment of lung cancer, as indicated by low mortality and complication rates: subcutaneous emphysema (5; 4.90 %), recurrent pneumothorax (3; 2.90 %), residual cavity (3; 2.90 %), bronchopleural fistula (4; 3.90 %), postoperative bleeding (1; 0.98 %), pulmonary artery anastomosis thrombosis (1; 0.98 %), acute respiratory distress syndrome with respiratory failure (3; 2.90 %), acute myocardial infarction (2; 1.92 %), coagulated hemothorax (1; 0.98 %), pulmonary embolism (1; 0.98 %). Postoperative mortality — 4 (3.90 %.)Conclusions. It has been established that bronchoplastic operations have a low number of complications in the postoperative period — 22 (21.5 %). In planning the type of bronchoplastic when planning the type of bronchoplastic surgery, preference should be given to circular resection of the bronchial resection, as it reliably reduces the number of reoperations due to complications: in the wedge resection group 9 reoperations (15 %) were required in the wedge resection vs. wedge resection group versus 2 (4.4 %) in the circular resection group (p < 0.05). However, the choice of resection technique does not affect either the number of complications or the rate of local recurrence development.