gms | German Medical Science

Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizer Gesellschaft für Thoraxchirurgie

07. - 09.10.2010, Wien (Österreich)

Outcome of patients undergoing sleeve resections with unprotected bronchial anastomoses

Meeting Abstract

  • M. Tutic - Universitätsspital Zürich, Deutschland
  • E. Strorelli - Universitätsspital Zürich, Deutschland
  • D. Schneiter - Universitätsspital Zürich, Deutschland
  • P. Kestenholz - Universitätsspital Zürich, Deutschland
  • I. Opitz - Universitätsspital Zürich, Deutschland
  • W. Weder - Universitätsspital Zürich, Deutschland

Deutsche Gesellschaft für Thoraxchirurgie. Österreichische Gesellschaft für Thoraxchirurgie. Schweizerische Gesellschaft für Thoraxchirurgie. Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizer Gesellschaft für Thoraxchirurgie. Wien, Österreich, 07.-09.10.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10dgtP38

doi: 10.3205/10dgt067, urn:nbn:de:0183-10dgt0676

Published: September 30, 2010

© 2010 Tutic et al.
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Outline

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Background: In patients with a centrally located broncho-pulmonary lesion, sleeve resection is the operation of choice in order to avoid a pneumonectomy. Most centers wrap the bronchial anastomoses with viable tissue to protect them from insufficiencies. In this study we report our single center experience in patients with unwrapped anastomoses and to assess possible postoperative complications and outcome.

Methods: Between 2000 and 2009 103 patients with a mean age of 58±1,3 underwent unwrapped bronchial sleeve resections. Retrospectiv review of the data for the types of sleeve-resections, neoadjuvant therapy stage and morbidity.

Results: 27 patients had a concomitant vascular sleeve-resection, 25 neoadjuvant chemotherapy and 5 radio-chemotherapy. Sleeve-lobectomy was performed in 88, sleeve-bilobectomy in 8, sleeve-pneumonectomy in 4 and sleeve-resection of the main bronchus in 3 patients. The histology revealed a squamous cell carcinoma in 45, an adenocarcinoma in 23, a large cell carcinoma in 6, a small cell carcinoma in 2, a mixed non small cell lung carcinoma in 3, a neuroendocrine tumor in 19 and 5 with other histological types. The pathologic tumor stage in NSCLC revealed stage I in 25, stage II in 24, IIIA in 16, IIIB in 7 and IV in 2 patients. There were no anastomosis related complications especially no fistulas. 24 patients had early postoperative complications, including surgery-related complications in 10 (air-leakage, nerve injury, hematothorax or mediastinal emphysema). 3 patients had long-term complications:1 intermediate bronchial narrowing without need of intervention and 2 postpneumonectomy empyemas. The in hospital mortality was 3% (one patient died due to heart failure and two with multiorgan failure). The 5 years survival was 57%.

Conclusions: Sleeve resections in patients without wrapping the bronchial anastomoses is feasible and safe in an experienced center. Neoadjuvant treatment did not interfere with healing. Therfore wapping of the bronchial anastomises is not necessary to be performed routinely.

Disclosure: No significant relationships.