Background: To explore the effectiveness of video-assisted thoracoscopic surgery (VATS) bronchial sleeve resection and reconstruction.
Methods:The clinical data of patients who had received VATS bronchial sleeve lobectomy in our center from January 2008 to February 2015 were retrospectively analyzed.Results: Totally 118 patients (105 men and 13 women) received the VATS bronchial sleeve lobectomy. The procedures included sleeve resection of right upper lobe (n=59), right middle lobe (n=7), right lower lobe (n=8), left upper lobe (n=34), and left lower lobe (n=10). The lesions were confirmed to be squamous cell carcinoma (n=68), adenocarcinoma (n=16), mucoepidermoid carcinoma (n=8), adenosquamous carcinoma (n=7), large cell carcinoma (n=1), carcinoids (n=5), and others (n=13; including small cell carcinoma, pleomorphic carcinoma, and inflammatory myofibroblastic tumor). Operations lasted 118-223 min [mean ± standard deviations (SD): 124.00±31.75 min]. The length of removed bronchus was 1.50-2.00 cm (mean ± SD: 1.75±0.26 cm). The duration of bronchial anastomosis (from the first puncture to the completion of knotting) was 15-42 min (mean ± SD: 30.20±7.97 min). The number of dissected lymph node stations (at least three mediastinal lymph node stations, including station 7) was 5-9 stations (mean ± SD: 6.50±1.18 min).The number of dissected lymph nodes was 10-46 (mean ± SD: 26.00±10.48). The intraoperative blood loss was 20-400 mL (mean ± SD: 71.00±43.95 mL), and no blood transfusion was performed. All patients were observed in intensive care unit (ICU) for 1 day. Postoperative drainage was performed for 3-8 days (mean ± SD: 5.00±1.49 days). Postoperative hospital stay was 3-8 days (mean ± SD: 5.10±2.07 days).Conclusions: VATS bronchial sleeve resection and reconstruction is a safe and feasible technique. Many literatures have demonstrated the advantages of VATS techniques, which include small incision, short hospital stay, mild postoperative pain, and small lung damage (3-6). All these advantages are helpful to facilitate post-operative recovery. In recent years, along with improvements in both VATS surgical skills and devices, some doctors have attempted this technique in more challenging procedures such as complete VATS tracheal and bronchial sleeve lobectomy in patients with more complex central-type lung cancer (5,7).When tumor invades the bronchial openings and main bronchus, simple pulmonary Lobectomy can not thoroughly remove the tumor, whereas total pneumonectomy severely damages the lung function and can not be tolerated by most patients. In these patients, bronchial sleeve lobectomy may be the preferred surgical treatment (8,9). In 1947, Prince Thomas performed the first case of right upper lobe sleeve resection; since then, bronchial sleeve lobectomy has become a standard procedure for lung cancer (10). Compared with total pneumonectomy, bronchial sleeve lobectomy can achieve comparable long-term survival but with small damage to lung function; thus, it can lower the surgical mortality and improve the lon...
