Total lung sparing surgery for tracheobronchial low-grade malignancies

BACKGROUND: Total-lung sparing tracheo-bronchial sleeve resections are a step forward in the treatment of low-grade bronchial tumors where minimal resection margins are required to achieve the complete control of the disease.METHODS: We retrospectively collected the data of patients who underwent total-lung sparing procedures for low-grade trachea-bronchial tumors at two thoracic surgery centres from January 1984 until October 2019.RESULTS: We selected 98-patients, 46-females(47%) and 52-males(53%) with a median age of 39years(range7-70). Thirty-four patients underwent an operative endoscopy before surgery(32-laser-treatment,2-endobronchial-stenting). The surgical resection were 9(9%)-tracheal carina, 18(18%)-second carina, 31(32%)-left main bronchi, 25(26%)-right main bronchi and 15(15%)-intermediate-bronchus. The median length of the resected bronchus was 2.2cm. Median post-operative in-hospital stay was 8-days, no perioperative mortality was observed. Postoperative complications were recorded in 26-patients(27%). The final histology was 37-typical carcinoids(38%), 10-atypical carcinoids(10%), 29-adenoid cystic carcinomas(30%), 15-mucoepidermoid carcinomas(15%), 6-inflammatory myofibroblastic tumors(6%) and 1-glomic tumor(1%). Twenty-two patients had positive resection margins and received adjuvant radiotherapy. Three patients with adenoid cystic carcinoma had recurrence(1-local,2-systemic). After a median follow-up time of 54.5months(range4-360), the overall actuarial 5-year survival was 97%.CONCLUSIONS: Total-lung sparing tracheo-bronchial sleeve resection for low-grade malignancy require high surgical skills but the hospital morbidity and mortality are very low. This Technique is adequate and safe for highly selected patients with low-grade endobronchial malignancies and it's use should be encouraged in experienced centres