Techniques and outcomes of bronchoplastic and sleeve resection: an 8-year single-center experience

Abstract

Background: Bronchial reconstruction is one of the most challenging procedures for thoracic surgeons. This study aimed to report the surgical techniques and clinical outcomes of bronchoplastic and sleeve resection for central lung cancer and summarize our center's experience of this challenging procedure over the past 8 years.

Methods: Between January 2013 and April 2021, 54 patients underwent a sleeve resection or a lobectomy with bronchoplasty, including 11 patients who received video-assisted thoracoscopic surgery (VATS) bronchial sleeve resection (4 via the uniportal approach and 7 via the biportal approach). Perioperative parameters and surgical short-term patient outcomes were analyzed to evaluate the safety and feasibility of this surgical procedure.

Results: The average operative time and blood loss were 247.8±73.1 (range, 126-455) minutes and 300.4±321.8 (range, 50-1,500) mL, respectively. The mean postoperative length of stay was 10.5±5.8 (range, 4-29) days. Eleven patients underwent additional pulmonary angioplasty or sleeve resection. For patients who underwent biportal VATS sleeve lobectomy, the median operative time was 255 (interquartile range, 179-360) minutes, the median blood loss was 200 (interquartile range, 100-600) mL, and the median postoperative hospital stay was 5 (interquartile range, 5-8) days. For patients who underwent uniportal VATS sleeve lobectomy, the median operative time was 288 (interquartile range, 241.5-343) minutes, the median blood loss was 75 (interquartile range, 50-100) mL, and the median postoperative hospital stay was 5 (interquartile range, 4.5-5.5) days. No anastomosis-related complications or perioperative mortality was observed.

Conclusions: Both bronchoplastic resection and sleeve resection are safe and feasible procedures. Uniportal thoracoscopic sleeve lobectomy can be performed by skilled surgeons with satisfactory short-term outcomes, although it is surgically complicated.

Keywords: Bronchoplasty; lung cancer; sleeve lobectomy; thoracotomy; uniportal video-assisted thoracic surgery (UVATS); video-assisted thoracic surgery (VATS).

Figure 1

Uniportal video-assisted thoracoscopic right upper sleeve lobectomy in a patient. (A) Preoperative three-dimensional reconstruction of the right pulmonary anatomic structure conducted using Exoview. The bronchi are marked in white; the pulmonary arteries are marked in red; the pulmonary veins are marked in blue; the tumor is marked in yellow. (B) The distal bronchus was transected with scissors to adapt the diameter of the stump of the main bronchus. (C) A tensionless continuous suture was started from the posterior side. (D) The anterior wall of the bronchus was then sutured to complete the reconstruction.

Figure 2

Uniportal video-assisted thoracoscopic left upper sleeve lobectomy in a patient. (A) Preoperative three-dimensional reconstruction of the left pulmonary anatomic structure conducted using Exoview. The bronchi are marked in white; the pulmonary arteries are marked in red; the tumor is marked in yellow. (B) Pulmonary artery suspension devices were used to reduce the complexity of the surgery. (C) A tensionless continuous suture was started from the posterior side. (D) The anterior side of the bronchus was then sutured to complete the reconstruction.