[Lobar bronchoplasty for tumor. Surgical technique and long-term results]

Between 1978 and 1994, 55 patients (53 men and 2 women) with a mean age of 62 years underwent an extended lobectomy to the main bronchus, with bronchial re-anastomosis, for bronchogenic tumours located around the lobar orifice. There were 32 upper sleeve lobectomies (58%) with a wedge resection of carina in one instance, 7 lower mono/bilobectomies with an upper lobe "turn up" re-anastomosis (13%) and 16 upper wedge lobectomies (29%). Squamous cell carcinoma was predominant (32 patients, 58%), while the adenocarcinoma was present in 16%, adenosquamous in 5%, microcitoma in 9%, carcinoid in 4% and a well differentiated neuro-endocrine carcinoma in 2%. The indication for the bronchoplastic procedure was judged to be when the FEV, value was about -25% of the normal; in a few patients still in good respiratory condition, an elective indication was also admitted. Postoperative staging was: Stage 0 in 1 patient, Stage I in 7 patients; Stage II in 10 patients; Stage III A in 31 patients; Stage III B in 5 patients and Stage IV in 1 patient. Follow-up was completed with a mean extension of 40 months (range 3 months-16 years). There was no operative mortality in Stages I and II as well as in Stages III B and IV, while it was 9% in Stage III A patients. Survival rates according to the stage were as following: 66% 5 and 10 year for Stage I disease; 56% 5 year and 45% 10 year for Stage II disease; 7% 4 year for Stage III A. None of 5 patients belonging to Stage III B has survived for more than 18 months (mean 7). Some single survivals are mentioned because of their special clinical features. Besides stressing the absolute value of survival rates obtained in Stage I and II disease, the Author also point out the clinical role of these advanced surgical techniques in improving both the survival length and the quality of life, when applied for the treatment of more advanced Stage III A.