Bronchovascular Sleeve Resection

Updated: Oct 31, 2019
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Overview

Background

Lung cancer is the second most common cancer and the number one cause of cancer-related deaths in both males and females in the United States. [1] Treatment options include surgery, chemotherapy, and radiotherapy, depending on the stage of the lung cancer. [2]

Since the introduction of pneumonectomy in 1895 by William Macewen, a number of options for surgical treatment of lung cancer have been developed. Sleeve resection was first described in 1947 by Prince-Thomas. [3] Allison in 1959 reported the first sleeve lobectomy with pulmonary artery construction. Sleeve lobectomy was considered inferior to pneumonectomy, but subsequent work has shown that sleeve lobectomy has better outcome and lower morbidity and mortality than pneumonectomy. [4, 5, 6]

Video-assisted thoracoscopic surgery (VATS) has been used to perform sleeve lobectomy with a minimally invasive approach. Although results have been encouring, thoracoscopic sleeve resection remains a challenging operation with a steep learning curve that should be reserved for experienced surgeons. [7]

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Indications

See the list below:

  • Tumor invading or protruding into main stem bronchus

  • As an alternative to pneumonectomy in patients with poor cardiopulmonary reserve

  • Endobronchial bronchogenic carcinoma

  • Carcinoid tumors and low-grade malignancy (eg, bronchial gland carcinomas), if complete resection can be obtained

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Contraindications

See the list below:

  • Complete resection of tumor not achievable by bronchovascular sleeve resection

  • N2 disease (a relative contraindication)

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