History and current status of bronchoplastic surgery for lung cancer.

Sleeve lobectomy for carcinoma of the lung was first described as a compromised operation for patients whose pulmonary reserve was considered inadequate to permit pneumonectomy. Since then, many authors have suggested that bronchoplasties may provide as good if not better results than pneumonectomy in selected cases of primary carcinoma of the lung involving the proximal bronchial tree. In all reported series, lesions in the hilum of the right upper lobe are the commonest indication for sleeve lobectomy, although all lobes and segments of the lungs may on occasion be involved with tumors that are amenable to some form of lung-sparing bronchoplastic procedure. As a general statement, bronchoplasties should be considered in any case of lung cancer that can be completely resected by these techniques although some controversy persists about the application of these procedures in patients with N(1) or N(2) disease. Published reports document a 30-day operative mortality of 0%-5%. Complications peculiar to sleeve lobectomy are an increased incidence of retained secretions, bronchovascular fistulas, and a potential for an increased incidence of local recurrence. Most major reports document a 5-year survival of 40%-50% and functional results that are significantly better than those obtained following pneumonectomy.