Avoiding pneumonectomy in chronic complete lung atelectasis: sleeve right upper lobectomy for right main bronchus...

Complete lung atelectasis resulting from main bronchial obstruction may arise from both benign and malignant etiologies. Diagnosis is often delayed, particularly in younger patients, leading to prolonged lung collapse and compensatory hemidiaphragmatic elevation. Pneumonectomy is traditionally considered in such cases, lung-sparing resections should be preferred, especially in young individuals. The indication for sleeve resection in the setting of long-standing complete atelectasis remains controversial.

We report the clinical presentation, surgical management, and outcomes of two patients with chronic dyspnea and presented with long-standing complete right lung atelectasis secondary to right main bronchus obstruction, treated with lung parenchyma-sparing procedures. A 30-year-old woman with post-tuberculosis bronchial stenosis (treated in 2018 at the Institute of Pneumonology "Marius Nasta", Bucharest) and a 34-year-old man with a typic endobronchial carcinoid tumor (treated in 2025 at the Centre Hospitalier Monkole, Kinshasa) were included. Both patients underwent right upper sleeve lobectomy by lateral thoracotomy. They were discharged on day 6, with an uneventful short- and long-term outcomes, including rapid improvement of pulmonary function.

Even in cases of prolonged complete lung atelectasis due to main bronchial obstruction, lung-sparing resection is feasible and effective. It avoids pneumonectomy and is not associated with increased perioperative or long-term complications.