Sleeve Lobectomy: To Wrap or Not to Wrap the Bronchial Anastomosis?

Campisi, Alessio; Ciarrocchi, Angelo Paolo; Congiu, Stefano; Mazzarra, Sara; Sanna, Stefano; Argnani, Desideria; Grani, Giorgio; Davoli, Fabio; Salvi, Maurizio; Stella, Franco

doi:10.1016/j.athoracsur.2021.01.038

Cited by 5 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After the anastomosis was completed, airtightness was checked with an inflation pressure of 30 cm of water and inspected intraoperatively by bronchoscopy. To potentially prevent the anastomotic fistula, the anastomotic site was covered by vascular pedicled intercostal muscles, pleural flaps, thymus tissues, or fibrin glue (19,21,22).…”

Section: Surgical Techniquesmentioning

confidence: 99%

Carinal resection and reconstruction with complete pulmonary parenchyma preservation: a single-institution analysis of 36 cases

Chen¹,

Wang²,

Zhao³

et al. 2021

Transl Lung Cancer Res

View full text Add to dashboard Cite

Background: Carinal resection, performed in only a few high-volume centers, remains one of the most complicated and technically demanding surgeries. Few studies have examined the outcomes of carinal resection and reconstruction with complete pulmonary parenchyma preservation.Methods: Patients who underwent isolated carinal resection and reconstruction at the Shanghai Chest Hospital between 2006 and 2020 were retrospectively reviewed. Clinicopathological, perioperative, and follow-up outcomes were analyzed.Results: A total of 36 patients were included, including 19 men and 17 women. The average age was 50.7±14.8 years. Right posterolateral thoracotomy (n=33, 91.7%) and cross-field intubation during anastomosis (n=31, 86.1%) were selected for the majority of the carinal surgeries. The average intraoperative blood loss was 225.0 mL, and the mean operation duration was 196.1 minutes. Postoperative complications were observed in 14 patients (38.9%), including cicatricial stenosis (n=8, 22.2%), anastomotic fistula (n=3, 8.3%), air leak (n=1, 2.8%), cardiac arrhythmia (n=4, 11.1%), pneumonia (n=2, 5.6%), respiratory failure (n=1, 2.8%), and pulmonary embolism (n=1, 2.8%). There were 2 perioperative deaths (5.6%). Multivariate analysis revealed that being overweight was an independent favorable factor for postoperative complications [P=0.042, odds ratio (OR) =0.092, 95%, confidence interval (CI): 0.009-0.922]. Pathological diagnoses included squamous cell carcinoma (SCC) (n=12, 33.3%), adenoid cystic carcinoma (ACC) (n=15, 41.7%), mucoepidermoid carcinoma (MEC) (n=2, 5.6%), stricture (n=1, 2.8%), and other rare histological types. An R0 resection was achieved in 14 patients, while 21 patients (60.0%) had microscopically positive margins.Lymph node metastasis was confirmed in 6 patients (17.1%). Overall survival (OS) was 94.4% at 1 year and 79.4% at 5 years, with 107 months as the median survival time (95% CI: 64.0-150.0 months). All patients with negative margins remained alive during the follow-up period, while those who received R1 resections had much poorer survival rates due to tumor recurrence [P=0.042, hazard ratio (HR) =4.938, 95% CI: 1.062-22.950]. Conclusions:In selected patients, carinal resection and reconstruction with complete pulmonary parenchyma preservation was a feasible option to achieve an appreciable long-term survival at the risk of acceptable operative mortality and morbidity, particularly when complete resection with negative margins could be realized.

show abstract

Section: Surgical Techniquesmentioning

confidence: 99%

Carinal resection and reconstruction with complete pulmonary parenchyma preservation: a single-institution analysis of 36 cases

Chen¹,

Wang²,

Zhao³

et al. 2021

Transl Lung Cancer Res

View full text Add to dashboard Cite

show abstract

“…The techniques include multiple interrupted sutures using absorbable VICRYL, running 3 to 0 Prolene suture, or a combination of both. 4 , 8 , 40 All of the bronchial anastomoses in the present study were made using continuous running suture with 3 to 0 Prolene. Notes on our experiences using this method are as follows: The process of running 3 to 0 Prolene suture with bulldog clamps holding the other suture end can smooth and simplify the anastomosis and avoid suture twisting.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 6 – 8 Some current studies have pointed out that visual compensation may be a better alternative to the tactile feedback once the surgeon is proficient. 8 , 9 Therefore, we created a new modified approach to RA sleeve lobectomy optimization in order to improve surgical field visualization and simplify anastomosis techniques. The study retrospectively reviewed and analyzed the clinical data for sleeve lobectomy using the optimized RAS and mini-thoracotomy (MT), especially focusing on the efficacy, safety, and postoperative outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Although their results are encouraging, a longer learning curve, lack of tactile feedback to the operator, and tricky bronchial anastomosis RAS techniques are all associated issues that remain unresolved. [6][7][8] Some current studies have pointed out that visual compensation may be a better alternative to the tactile feedback once the surgeon is proficient. 8,9 Therefore, we created a new modified approach to RA sleeve lobectomy optimization in order to improve surgical field visualization and simplify anastomosis techniques.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of Sleeve Lobectomy for Lung Cancer Using Mini-Thoracotomy and an Optimized Robot-Assisted Technique

Tao

Yuan

Kang

et al. 2021

Technol Cancer Res Treat

View full text Add to dashboard Cite

Objective: To evaluate the clinical significance of an optimized approach to improve surgical field visualization and simplify anastomosis techniques using robotic-assisted sleeve lobectomy for lung or bronchial carcinoma. Method: A total of 26 consecutive patients who underwent sleeve lobectomy between January 2017 and April 2020 were enrolled in the study. The cohort included 11 cases of robotic-assisted surgery (RAS group) and 15 cases of mini-thoracotomy (MT group). RAS was performed via an exclusive optimized approach utilizing the “3 to 4-6 to 8/9” four-port technique. Retrieved demographical and clinical data included operation time, anastomosis time, blood loss, chest drainage time and volume, postoperative pain scores, complications, white blood cell (WBC) levels, and duration of hospital stay and follow-up. Results: No cases of perioperative death were recorded. Compared to MT group, the RAS group had a similar anastomosis time (30.82 ± 6.08 vs 33.20 ± 7.73 min, respectively, p > 0.05) and shorter operation time (189.73 ± 36.41 vs 225.33 ± 38.19 min, respectively, p < 0.05). The RAS group had lower pain scores (4.23 ± 0.26 vs 4.91 ± 0.51, p < 0.05), lower levels of WBC (p < 0.05), and no anastomotic complications postoperatively. The RAS and MT groups demonstrated a successful bronchus reconstruction with low risk of angulation (1/11 vs 1/15, p > 0.05) and satisfactory disease-free survival (eight cases, 72.73% and 12 cases, 80%, respectively). Conclusion: The optimized approach to RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes. Further study with a large sample size and evaluation of long-term survival are warranted. Key points: (i) we present a novel, convenient, and efficient approach for robotic-assisted sleeve lobectomy, ie, “3 to 4-6 to 8/9” four-port technique. The optimized approach for RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes; (ii) details for the “3 to 4-6 to 8/9” four-port method: the assistant port was located at the fourth intercostal space. The 1-cm camera port was inserted at the sixth intercostal space in the posterior axillary line. The 0.5-cm da Vinci ports of the instrument arms were placed at the third intercostal space in the anterior axillary line and the eighth or ninth intercostal space in the posterior axillary line. The patient cart was inserted from the back of the patient's head and shoulders at 75° to the longitudinal line.

show abstract

Evaluation of Risk Factors for Early Insufficiency after Bronchial Sleeve Resections

Levchenko,

Shabinskaya,

Levchenko

et al. 2024

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Background: Bronchoplastic resections are now widely used as a surgical treatment for resectable central lung cancer. However, bronchial dehiscence is one of the most life-threatening complications, making it important to identify its risk factors to separate patients who require more attention during the postoperative period. Methods: The data of 285 patients who underwent bronchoplasty from 2006 to 2021 were retrospectively reviewed. We collected demographic characteristics, history of neoadjuvant therapy, preoperative assessment, perioperative outcomes, and postoperative complications to investigate different variables as risk factors for bronchial dehiscence by univariate and multivariate analyses. Results: Bronchial dehiscence was diagnosed in 12 patients (4.2%) with a mean presentation on postoperative day 10 (range: 1–24 days). By multivariate analysis, current smoking (odds ratio (OR): 4.8, 95% confidence interval (CI): 1.1–20.1, p = 0.032), chronic obstructive pulmonary disease (OR: 6.5, 95% CI: 1.2–33.8, p = 0.027), bronchoplastic right lower lobectomy (OR: 12.9, 95% CI: 2.4–69.7, p = 0.003), and upper sleeve bilobectomy with segmentectomy S6 by performing an anastomosis between right main bronchus and bronchus of basal pyramid (OR: 30.4, 95% CI: 3.4–268.1, p = 0.002) were confirmed as relevant risk factors for developing bronchial dehiscence. Conclusions: Current smoking, COPD, bronchoplastic RLL, and upper bilobectomy with segmentectomy S6 by performing an anastomosis between RMB and bronchus of BP were identified with the occurrence of bronchial dehiscence after sleeve resection.

show abstract

Sleeve Lobectomy: To Wrap or Not to Wrap the Bronchial Anastomosis?

Cited by 5 publications

References 18 publications

Carinal resection and reconstruction with complete pulmonary parenchyma preservation: a single-institution analysis of 36 cases

Carinal resection and reconstruction with complete pulmonary parenchyma preservation: a single-institution analysis of 36 cases

Comparison of Sleeve Lobectomy for Lung Cancer Using Mini-Thoracotomy and an Optimized Robot-Assisted Technique

Evaluation of Risk Factors for Early Insufficiency after Bronchial Sleeve Resections

Contact Info

Product

Resources

About