Bronchoplastic and pulmonary arterioplastic procedures in the treatment of bronchogenic carcinoma

Bronchoplastic and pulmonary arterioplastic procedures have become increasingly popular in recent years as an alternative to pneumonectomy, especially for patients with compromised cardiopulmonary reserve. We reviewed our experience with the procedure to determine the operative technique, indication for the procedure and long-term results.

From January 1981 to December 2000, 65 bronchoplasties, four pulmonary arterioplasties and three combined broncho-angioplasties were performed for bronchogenic carcinoma.

Of the 72 patients, 31 had stage I disease, 29 had stage II and 12 had stage III disease. One patient (1.4%) died of bilateral pneumonitis postoperatively. Atelectasis occurred in two patients (2.8%), empyema in one (1.4%), and bronchial fistula in one (1.4%). There were no bronchial stenoses after bronchoplastic procedures, and no vascular complications after angioplastic procedures. The 1-, 3- and 5-year survival rates for the entire group were 86.0%, 47.0% and 29.8%, respectively. The difference in survival was significant between stage I and II disease (p=0.0001) and between stage I and III disease (p<0.0001), but not between stage II and III disease (p=0.0779).

Bronchoplastic, pulmonary arterioplastic and broncho-angioplastic procedures can be performed safely. Bronchoplastic procedures offer patients with bronchogenic carcinoma a long-term result comparable to that with radical lung resection. Angioplastic and combined broncho-angioplastic procedures should only be used in patients who cannot tolerate pneumonectomy due to poor cardiopulmonary reserve.