Improvement in postoperative lung function in patients with moderate to severe airway obstruction after robotic-assisted thoracoscopic tracheobronchoplasty

ObjectiveThe study objective was to examine pulmonary function and quality of life improvement after robotic-assisted thoracoscopic tracheobronchoplasty for patients with different degrees of obstructive airway disease.MethodsWe performed a retrospective review of a prospective database of patients who underwent robotic-assisted thoracoscopic tracheobronchoplasty between 2013 and 2020.ResultsA total of 118 patients underwent robotic-assisted thoracoscopic tracheobronchoplasty. Preoperative and postoperative pulmonary function tests were available for 108 patients. Postoperative pulmonary function tests at a median of 16 months demonstrated a significant increase in percent predicted forced expiratory volume in 1 second (preoperative median: 76.76% predicted, postoperative: 83% predicted, P = .002). Preoperative and postoperative St George Respiratory Questionnaires were available for 64 patients with a significant decrease in postoperative score at a median of 7 months (preoperative median: 61, postoperative: 41.60, P < .001). When stratified by preoperative degree of obstruction, robotic-assisted thoracoscopic tracheobronchoplasty improved forced expiratory volume in 1 second in moderate to very severe obstruction with a statistically significant improvement in moderate (preoperative median: 63.91% predicted, postoperative median: 73% predicted, P = .001) and severe (preoperative median: 44% predicted, postoperative median: 57% predicted, P = .007) obstruction. St George Respiratory Questionnaire scores improved for all patients. Improvement for mild (preoperative median: 61.27, postoperative median: 36.71, P < .001) and moderate (preoperative median: 57.15, postoperative median: 47.52, P = .03) obstruction was statistically significant.ConclusionsRobotic-assisted thoracoscopic tracheobronchoplasty improves obstruction and symptoms. With limited follow-up, subgroup analysis showed forced expiratory volume in 1 second improved in severe preoperative obstruction and quality of life improved in moderate obstruction. Future follow-up is required to determine robotic-assisted thoracoscopic tracheobronchoplasty effects on the most severe group, but we cannot conclude that increased degree of preoperative obstruction precludes surgery.     

Surgical results of 40 patients with malignant tracheobronchial lesions

Abstract The objective of this study was to evaluate the results of tracheobronchoplasty performed on a variety of malignant diseases which involved the tracheobronchus. Between July 1988 and March 1996 tracheobronchial surgery was performed on 40 patients who had a variety of malignant diseases. The primary diseases were bronchogenic carcinoma ( n = 26), tracheobronchial tumour ( n = 5), thyroid cancer ( n = 6), and oesophageal cancer ( n = 3). Operative procedures that were performed on the tracheobronchus were sleeve lobectomy ( n = 22) or bilobectomies ( n = 5), sleeve pneumonectomy ( n = 3), sleeve resection of trachea ( n = 7) and bronchus ( n = 3). There was one postoperative death with a mortality rate of 2.5%. However, there were no significant postoperative complications apart from the one postoperative death; one patient developed a bronchopleural fistula and empyema. In lung cancer patients, the 2 year survival rate was 47.3%, and one (3.8%) local tumour recurrence. Four of five patients who had tracheobronchial tumours were alive and free from disease during 2–6 year follow-up period. One patient who had malignant fibrous histiocytoma died of brain metastasis 6 months after the operation. Among six patients whose thyroid cancer involved the trachea, one patient survived for 7 years, the other five patients were still alive and free from disease 2–5 years after the operation. Of the three patients whose oesophageal carcinoma involved the tracheobronchus, there was one operative death and the others died of tumour recurrence 1 and 2 years, respectively. We suggest that tracheobronchoplasty is a safe procedure with low morbidity and mortality rates in carefully selected patients with malignant diseases.     

Tracheobronchoplasty yields long-term anatomy,function, and quality of life improvement for patients with severe excessive central airway collapse

ObjectivesThis study examines the long-term anatomic and clinical effects of tracheobronchoplasty in severe excessive central airway collapse.MethodsIncluded patients underwent tracheobronchoplasty for excessive central airway collapse (2002-2016). The cross-sectional area of main airways on dynamic airway computed tomography was measured before and after tracheobronchoplasty. Expiratory collapse was calculated as the difference between inspiratory and expiratory cross-sectional area divided by inspiratory cross-sectional area ×100. The primary outcome was improvement in the percentage of expiratory collapse in years 1, 2, and 5 post-tracheobronchoplasty. Secondary outcomes included mean response profile for the 6-minute walk test, Cough-Specific Quality of Life Questionnaire, Karnofsky Performance Status score, and St George Respiratory Questionnaire. Repeated-measures analysis of variance was used for statistical analyses.ResultsThe cohort included 61 patients with complete radiological follow-up at years 1, 2, and 5 post-tracheobronchoplasty. A significant linear decrease in the percentage of expiratory collapsibility of the central airways after tracheobronchoplasty was present. Anatomic repair durability was preserved 5 years after tracheobronchoplasty, with decrease in percentage of expiratory airway collapse up to 40% and 30% at years 1 and 2, respectively. The St George Respiratory Questionnaire (74.7 vs 41.8%, P < .001) and Cough-Specific Quality of Life Questionnaire (78 vs 47, P < .001) demonstrated significant improvement at year 5 compared with baseline. Similar results were observed in the 6-minute walk test (1079 vs 1268 ft, P < .001) and Karnofsky score (57 vs 82, P < .001).ConclusionsTracheobronchoplasty has durable effects on airway anatomy, functional status, and quality of life in carefully selected patients with severe excessive central airway collapse.     

气管支气管成形术治疗肺癌

27例采用肺癌气管支气管成形术治疗。其中左及右上叶袖状切除22例;右全肺切除、隆凸切除、左总支气管气管吻合1例;右全肺切除、气管侧壁切除、隆凸半切除3例;气管楔形切除1例。无手术意外及近期死亡。本文对手术指征、操作技术等提出了自己的经验。