TRACHEOBRONCHIAL SLEEVE RESECTIONS: PERSONAL EXPERIENCE WITH 53 CASES

1. TRACHEOBRONCHIAL SLEEVE RESECTIONS:PERSONAL EXPERIENCE WITH 53 CASES A. Kır, A. Kosif Mısırlıoğlu, A. Koşar, H. Yılmaz, L. Alpay, İ. İskender, A. Atasalihi Süreyyapaşa Chest Diseases and Thoracic Surgery Research and Training Hospital, 2. Thoracic Surgery Department, Istanbul

2. OBJECTIVE • Surgical indications • Anastomosis techniques • Morbidity • Mortality • Survival

3. MATERIALS & METHODS • September 1993 - January 2007 • Personal experience • 53 cases • 38 male, 15 female. • Mean age 54 (11-74)

4. PREOPERATIVE WORKUP • Physical examination • Chest X-Ray • Spirometry • Cardiac evaluation • Thorax CT, if necessary multislice CT • FOB and/or Rigid Bronchoscopy • Wholebody screening, PET/CT

5. ANESTHESIA MANAGEMENT • One lung ventilation (Robertshaw) • Ventilation across the operative field • Prolonged apneic oxygenation • TIVA(Propofol)

6. SURGICAL TECHNIQUE

7. SURGICAL TECHNIQUE • Suture material • No covering (except one case) • Mediastinoscopy (NSCLC) 28 / 35 cases • False (-) 3 / 28 cases • F/S during surgery

9. POSTOPERATIVE CARE • Effective pain control • Early mobilization • Active pulmonary exercises • If necessary FOB

10. Postoperative Diagnosis

11. ADDITIONAL SURGICAL PROCEDURES • 6 Angioplasty • 5 Pulmonary Artery • 1 SVC (reconstruction of pericardium) • 1 Vascular sleeve resection • Intrapericardial right sleeve pneumonectomy

12. COMPLICATIONS • NO complications in 30(%56,6) cases • 4 (%7.5) prolonged air leak • 3 (%5,7) atelectasia, bronchorea • 2 (%3.8) pneumonia, local recurrence, stenosis • 1(%1.9) perop rupture of left main bronchus, kink, empyema, pnmtx, BPF, expansion defect, ARDS

13. TREATMENT OF COMPLICATIONS • 6 (%11.3)bronchoscopy • 4 (%7,5)pneumoperitoneum • 2 (%3,8)tube thoracostomy, inoperable, medical treatment • 1 (%1,9)completion pneumonectomy, inf.bilobectomy , repair of fistula , br+dilatation, primary repair, follow up

14. SURGICAL MORTALITY 1 (%1,9) case dead in 10th postoperative day because of ARDS

15. FOLLOW UP • 30/53cases followed up41months. • 21/35 cases were NSCLC.

16. SURVIVAL (41 months) • %80 (16/21)

18. Bronchial Sleeve Resections Review

19. CONCLUSION Tracheobronchial sleeve resections can be performed safely with low morbidity and mortality in experienced hands!