The role of bronchoplastic procedures in the surgical management of benign and malignant pulmonary lesions.

ABSTRACT

Conservative pulmonary resection is appropriate for the majority of patients with endobronchial neoplasms of low-grade malignant potential in the proximal airways and for a small but significant number of patients with carcinoma. A portion of the bronchus is removed, with or without lobectomy, as a sleeve resection and a primary bronchial reanastomosis is performed to preserve ventilatory function. Bronchoplastic techniques can also be used to repair traumatic airway injuries and benign strictures. The present series of bronchoplastic procedures consists of 28 patients undergoing operation with pathological diagnoses of carcinoma in 20, adenoma in six, hamartoma in one, and a post-traumatic laceration in one. There were minimal morbidity and no deaths. From 1947 to 1981 a total of 565 bronchoplastic procedures have been reported in the literature. Of these, 504 were sleeve resections for carcinoma. The remaining 61 bronchoplastic procedures were for either excision of endobronchial adenomas or repair of airway injuries of strictures. It appears that bronchoplastic procedures are the ideal surgical therapy for benign endobronchial lesions, tumors of low-grade malignant potential, such as adenomas, and for repair of airway injuries. This approach is also applicable to a select group of patients with carcinoma of th lung, and long-term survival periods comparable to those achieved by pneumonectomy can be demonstrated.