Current Role of Bronchoplastic Procedure for Lung Cancer

The indication for a sleeve resection is well established: a tumor arising at the origin of a lobar bronchus but not infiltrating as far as to require pneumonectomy. In addition, a sleeve resection may be indicated when N1 nodes infiltrate the bronchus from the outside, as is often the case in the left upper lobe tumors. From a functional point of view, sleeve lobectomy is strictly indicated in patients who cannot withstand pneumonectomy, but recent experiences have shown that the advantages of sparing lung parenchyma are evident also in patients without cardio-pulmonary impairment. Most studies show similar or better survival results for parenchymal sparing resections if compared with pneumonectomy. Moreover, in the analysis of 5-year survival according to stage, sleeve lobectomy results in higher survival rates for stage I, II. The survival advantage in stage III appears to be limited and the benefit is not always confirmed for stage III-N2 patients. Postoperative morbidity and mortality data reveal overall better results for patients undergoing sleeve lobectomy with respect to pneumonectomy. The preservation of lung parenchyma has been indicated by some authors as the possible cause of a theoretical increased risk for locoregional recurrence after sleeve lobectomy. However, although in some experiences a higher local recurrence rate is reported for sleeve resection with advanced nodal status (N2), the few studies analysing risk factors for recurrence, show that the tumor stage and the nodal status are the only negative predictive factors, rather than the type of operation performed.