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Vol. 47. Issue 2.
Pages 66-72 (January 2011)
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Vol. 47. Issue 2.
Pages 66-72 (January 2011)
Original Article
DOI: 10.1016/S1579-2129(11)70016-7
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Lung sparing surgery by means of extended broncho-angioplastic (sleeve) lobectomies
Cirugía de preservación pulmonar mediante reconstrucciones broncoangioplásticas extendidas
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Abel Gómez-Caroa,??
Corresponding author
gomezcar@clinic.ub.es

Corresponding author.
, Samuel Garcíaa, María José Jiménezb, Purificación Matuteb, J.M. Gimferrera, Laureano Molinsa
a Servicio de Cirugía Torácica, Instituto del Tórax, Hospital Clínico, Universidad de Barcelona (UB), Barcelona, Spain
b Servicio de Anestesia y Reanimación, Hospital Clínico y Provincial de Barcelona, Universidad de Barcelona, Barcelona, Spain
Article information
Abstract
Objective

To determine the morbidity, mortality and survival of sleeve lobectomy procedures extended to more than one lobe compared with bronchoplasty.

Patients and methods

Between September 2005 and May 2010, a total of 535 patients diagnosed with bronchogenic carcinoma who fulfilled the criteria of clinical, oncological and functional operability were treated in our unit. Central tumors (n=95) that were unresectable using simple lobectomy were scheduled for sleeve lobectomy techniques or, if not possible, pneumonectomy.

Results

A total of 58 (11%) procedures were performed: 46 simple bronchoplastic lobectomies (SBL) and 12 extended sleeve lobectomies (ESL). In the SBL group, there were 32 bronchial (70%), 7 vascular (15%) and 7 bronchovascular (15%) reconstructions. In the ESL group, 8 (66.7%) were bronchial and 4 (33.3%) were bronchovascular reconstructions. The most frequent type of resection was the right upper lobe (RUL)+segment 6 in five (41%) cases, followed by RUL+middle lobe. There were 2 (3%) deaths in the SBL group. Morbidity was 34% in the SBL and 33% in the ESL group (P>0.05). Fifteen patients received neoadjuvant chemoradiotherapy for histologically-confirmed cN2; the number of complications, however, was not significantly higher. No risk factors were detected in any variable studied that would affect ESL compared to the SBL group (P>0.05). The patients in both groups with a higher morbidity were pN1, located in the left upper lobe and associated with vascular reconstruction (P<0.05). The overall five-year survival was 61.6%; SBL (61%) and ESL (68.9%) with no differences between groups (P>0.05).

Conclusions

ESL are technically more demanding procedures, but they do not increase morbidity or mortality compared to simple bronchoplasty, and have similar survival.

Keywords:
Sleeve lobectomy
Lung cancer
Complications
Lung Preservation
Resumen
Objetivo

Determinar la morbimortalidad y supervivencia de los procedimientos broncoangioplásticos extendidos a más de un lóbulo en comparación con las técnicas broncoangioplásticas simples.

Pacientes y métodos

Entre septiembre de 2005 y mayo de 2010, 535 pacientes diagnosticados de carcinoma broncogénico que cumplían criterios de operabilidad clínica, oncológica y funcional fueron tratados en nuestra unidad. Los tumores centrales(n=95) no resecables mediante lobectomía simple fueron programados para técnicas broncoangioplásticas y en caso de imposibilidad, neumonectomía.

Resultados

Se realizaron 58 (11%) procedimientos, 46 lobectomías broncoangioplásticas simples (LBS) y 12 extendidas (LBE). En el grupo de LBS (bronquiales 32 [70%], reconstrucción broncovascular 7 [15%] y vascular sola 7 [15%]). En el grupo de LBE, 8 (66,7%) fueron reconstrucciones bronquiales y 4 (33,3%) broncovasculares. El tipo de resección más frecuente es el lóbulo superior derecho (LSD)+segmento 6 en 5 (41%) casos, seguido del LSD+lóbulo medio. La mortalidad fue de 2 (3%) casos en el grupo LBS. La morbilidad ocurrió en el 34% LSB y en el 33% LBE (p>0,05). Quince pacientes recibieron tratamiento quimiorradioterápico neoadjuvante, por cN2 confirmado histológicamente, sin embargo no se detectó mayor número de complicaciones significativamente (p>0,05). No se detectaron factores de riesgo respecto a ninguna variable estudiada que afectaran a las LBE respecto a las LBS (p>0,05). En ambos grupos, los pacientes con mayor morbilidad fueron pN1, localización en lóbulo superior izquierdo y con reconstrucción vascular asociada (p<0,05). La supervivencia global a los 5 años fue 61,6% LBS (61%) y LBE (68,9%) sin diferencia entre ambos grupos (p>0,05).

Conclusiones

Las LBE son procedimientos técnicamente más demandantes pero no aumentan la morbimortalidad respecto a las técnicas broncoangioplásticas simples con una supervivencia similar.

Palabras clave:
Cáncer de pulmón
Complicaciones
Preservación pulmonar
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Copyright © 2011. Sociedad Española de Neumología y Cirugía Torácica
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