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. 2012 Apr 10:7:29.
doi: 10.1186/1749-8090-7-29.

Left main bronchus resection and reconstruction. A single institution experience

Mark Ragusa  1 , Jacopo Vannucci, Lucio Cagini, Niccolò Daddi, Roberta Pecoriello, Francesco Puma
Affiliations

Left main bronchus resection and reconstruction. A single institution experience

Mark Ragusa et al. J Cardiothorac Surg. .

Abstract

Background: Left main bronchus resection and reconstruction (LMBRR) is a complex surgical procedure indicated for management of inflammatory, benign and low grade malignant lesions. Its application provides maximal parenchymal sparing.

Methods: Out of 98 bronchoplastic procedures performed at the Authors' Institution in the 1995-2011 period, 4 were LMBRR. Indications were bronchial carcinoid in 2 cases, inflammatory pseudotumor in 1 case, TBC stricture in 1 case. All patients underwent preoperatively a rigid bronchoscopy to restore the airway lumen patency. At surgery a negative resection margin was confirmed by frozen section in the neoplastic patients. In all patients an end-to-end bronchial anastomosis was constructed according to Grillo.

Results: There were neither mortality nor major complications. Airway lumen was optimal in 3 patients, good in 1.

Conclusion: LMBRR is a valuable option for the thoracic surgeon. It maximizes the parenchyma-sparing philosophy, broadening the spectrum of potential candidates for cure. It remains a technically demanding procedure, to be carried out by an experienced surgical team. Correct surgical planning affords excellent results, both in the short and long term.

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Figures

Figure 1
Figure 1
Typical carcinoid. A: Preoperative airway volume rendering (CT) of bronchial tree. B: Surgical field after distal left main bronchus interruption (the polipoid tumor growth is visible within the proximal stump). C: Surgical field after bronchial resection. Construction of end-to-end anastomosis according to Grillo. D: Postoperative CT rendering.
Figure 2
Figure 2
Typical carcinoid. A: Preoperative CT scan demonstrating proximal left main bronchus lesion. B: Surgical field after distal left main bronchus interruption (the tumor growth had been previously debulked by endoscopic Nd:YAG laser ablation).
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