[Tracheobronchoplasty for lung cancer: operative indications by limited category]

Three limited categories of tracheobronchoplasty are applicable in lung cancer patients. A1 is for patients who would otherwise be inoperable due to the lack of cardiopulmonary reserve. R1 is for early-stage cancer localized to the hilar bronchus and which aims to preserve lung function by active limited category. R3 tracheo-bronchoplasty preserves respiratory function in noncurative cases. The percentage of patients undergoing A1, R1, and R3 tracheo-bronchoplasty were 14.2%, 16.8% and 4.2%, respectively (35.2% of total patients undergoing bronchoplasty). Of the total patients, 18.9% underwent carinoplasty, and of these only 4 (2.6%) were eligible for the 3 categories of tracheo-bronchoplasty. Of lung cancer patients who underwent bronchoplasty, A1 was performed in 12.6%, R1 in 16/3%, and R3 in 3.7% (32.6% of the total). The use of bronchoplasty increased from 7.8% to 21.9% of lung cancer surgery after the introduction of dose-intensive induction chemotherapy (DIIC), mainly due to the increase in the use of interlobar techniques (20.5% of the total) in the smaller bronchial lesions present after DIIC. The 5-year survival rates of patients undergoing A1, R1, and R3 tracheo-bronchoplasty were 59.6%, 64.9%, and 0%, respectively. No anastomotic recurrence was seen in the 32 patients who underwent R1. Based on these results, tracheo-bronchoplasty increases survival in patients who receive the A1 category and preserves lobar function in those who receive R1 and R3.