Bronchoplastic procedure with pulmonary angioplasty for lung cancer

Seventy-one patients with primary bronchogenic carcinoma Underwent bronchoplastic procedures (48 sleeve lobectomies and 23 wedge resection) from 1969 to 1986. In 16 patients the bronchoplasty with concomitant resection of pulmonary artery was performed. There were 48 squamous cell carcinomass, 13 adenocarcinomas, six large cell and four small cell carcinomas. There was no nodal metastasis in 26 patients (36.6%), 27 patients (38.0%) had mediastinal nodes involvement. Pathological stages of the disease were as follows : Stage I , one patients ; Stage II, 13 patients ; Stage III, 41 patients ; and Stage IV, one patient. Five year survival rate was 25.4%. Survival rates on the basis of nodal involvement indicate 44.1% at five years for patients without nodal metastasis and 18.4% for those with nodal involvement. Ten patients complained difficulty in expectoration after surgery, and frequent therapeutic bronchofiberscopy was necessary. Four patients had an early bronchial fistula. Bronchial stenosis or obstruction due to formation of suture granulation occurred in six patients, and local recurrence at bronchial suture line was observed in six patients. Three patients with resection of the pulmonary artery had vascular complications. In two patients obstruction of the pulmonary artery due to formation of thrombus occurred, and in one patient pulmonary artery was twisted. Bronchoplastic procedure can be perfomed safely, but if angioplasty of the pulmonary artery was concomitantly performed, it shoule be done carefully to prevent vascular distortion or stenosis. Since the description of bronchoplastic procedures by Paulson and Shaw in 1955 and Price Thomas in 1956, many reports have documented on the merits of these procedures. Sleeve lobectomy for lung cancer is an alternative to pneumonectomy, when the tumor extends into main bronchus. This operative procedure benifits the patients by conservation of lung tissues for whom pneumonectomy is not indicated because of poor pulmonary reserve. This report summarized our 17 years' experience in lobectomy with bronchoplastic procedures and angioplasty of the pulmonary artery