Techniques of pneumonectomy. Sleeve pneumonectomy.

Sleeve pneumonectomy is a technically demanding procedure, the indications of which include non-small bronchogenic tumors extending to the tracheobronchial bifurcation without diseased mediastinal nodes. Right sleeve pneumonectomies are best approached through an ipsilateral thoracotomy in the fifth (or fourth) intercostal space. Median sternotomy for left sleeve pneumonectomy gives outstanding exposure to the tracheobronchial bifurcation, and less incisional discomfort and ventilatory restriction than an ipsilateral thoracotomy. If a tracheobronchial anastomosis is under tension, excessive tracheobronchial and mediastinal dissection and perioperative fluid overload are avoided, then the most common and often fatal early (noncardiogenic pulmonary edema) and late (anastomotic dehiscence) complications are significantly lowered. If these guidelines are respected, this operation generates 5-year survival rates exceeding 40%.