Bilateral sleeve lobectomy for metachronous multiple primary lung cancer

In a patient with metachronous multiple primary lung cancer, bilateral lobectomy was performed, using bronchoplastic procedures. This case may be one of very few such cases reported in the literature. A 56-year-old man with squamous cell carcinoma was surgically treated for lung cancer. At the first operation, right upper lobectomy with wedge resection of the right main bronchus was performed, as the tumor occupied the orifice of the right main bronchus. Six months later, re-operation for stricture at the anastomotic line was done because of granulation. By means of sleeve resection of the strictured right main bronchus, the airway was reconstructed. The patient remained well for five years, then a similar cancer at the orifice of the left lower lobe and bulging into the left main bronchus became evident. Left lower sleeve lobectomy was done for the second primary cancer. The postoperative course was uneventful and he is well with no signs of recurrence 6 years and 10 months after the first operation and 19 months after the second sleeve lobectomy.     

Carinal resection and reconstruction for recurrent lung cancer

A patient with a recurrent tumor in the trachea adjacent to the right main bronchus was treated by surgical resection 19 months after undergoing surgery for the primary cancer. The patient had previously undergone right upper lobectomy for T1N0M0 stage I squamous cell carcinoma. A carinal resection was performed which included 4 rings of the trachea, 2 rings of the righ main bronchus, and 1 ring of the left main bronchus. Reconstruction consisted of an end-to-end anastomosis of the trachea and left main bronchus, and an end-to-side anastomosis of the right and left main bronchi. The postoperative course was uneventful, and at present the patient is healthy 12 months following reoperation.     

Second surgical intervention for contralateral recurrence or second primary lung cancer

Resection of contralateral lung cancer (6 cases of pulmonary metastasis from the first lung cancer and one case of second primary lung cancer) were evaluated retrospectively in terms of postoperative complication, pulmonary function and survival rate. Out of 691 cases with resected non small cell lung cancer, 7 cases (1.0%) had contralateral lung cancer which were resected as the second operation. Six cases were squamous cell carcinoma and one case was adenocarcinoma. The interval between the first and the second operation was 12 months to 10 years (average 46 months). The post-operative stage of first lung cancer were stage I in 5 cases and stage IIIB in 2 cases, but no case had lymphadenopathy at the first operation. Operative procedures for contralateral lung were as follows; one case of lobectomy----lobectomy, one case of lobectomy----segmentectomy, two cases of lobectomy----partial resection, two cases of pneumonectomy----partial resection. For a metachronous lung cancer, right upper sleeve lobectomy was done as the first operation followed by left lower sleeve lobectomy as the second cancer five years later. Contralateral lung resection impaired pulmonary function, but all cases well tolerated the second operation. The five-years survival rate after second operation was 40.0%.     

Successful lingular segmentectomy using bronchoplasty in a patient with early hilar second primary lung carcinoma

A 71-year-old man was admitted to our hospital with a small protrusive lesion at the lingular orifice of the left upper bronchus. He had undergone a right lower lobectomy and mediastinal dissection for lung carcinoma (large cell carcinoma, pT1N0M0) 14 months earlier. Early hilar squamous cell carcinoma was diagnosed by chest radiograph, CT and transbronchial biopsy. We performed a lingular segmentectomy with wedge resection of the left upper bronchus and N 1 lymph node dissection. The tumor was histopathologically diagnosed as early hilar second primary lung carcinoma. The patient's postoperative course was uncomplicated. At present, he is alive with good respiratory condition and without any evidence of recurrence. Segmentectomy is appropriate for a patient with contralateral second primary lung carcinoma as well as a patient with early hilar lung carcinoma. Bronchoplasty seems to increase the likelihood that such a patient will be a candidate for segmentectomy.     

Endobronchial Lipoma Accompanied with Primary Lung Cancer: Report of a Case

A 72-year-old man was found to have an endobronchial lipoma accompanied with primary lung cancer. A left lower lobectomy with a mediastinal lymph node dissection and a sleeve resection of the lingual bronchus with telescoping bronchial anastomosis were done. The pathological staging was T1N2M0, stage IIIA. A histological examination showed well-differentiated squamous cell carcinoma in segment 10, in addition to the presence of mature adipose tissue which was diagnosed to be a benign endobronchial lipoma originating from the lingual bronchus. The postoperative course was uneventful and the patient was discharged 13 days after the operation. However, he had a recurrence in the subcarinal lymph node, and died 8 months after surgery. Received: March 2, 2001 / Accepted: November 20, 2001     

A case of surgically treated simultaneous bilateral squamous cell carcinoma of the lung

A case of simultaneous, bilateral squamous cell carcinoma of the lung was presented. One located in right basal bronchus had mediastinal lymph node metastasis even though primary lesion was localized within the bronchial wall. So right lower lobectomy with R 2 lymph node dissection was carried out. The left one located in the left basal bronchus was treated using laser preoperatively, which revealed its location and extension. Sequentially S6 segmental sleeve resection was carried out and preserved his residual lung function. Six months later, the third primary lung cancer was found in left B3. We discussed about diagnosis and treatment of the multiple lung cancer and emphasize that bronchoplastic procedures in segmental level is available for treatment of multiple lung cancer.     

Long-term clinical and functional results of sleeve lobectomy for primary lung cancer

Sleeve lobectomy is a lung-saving operation in which a portion of main bronchus is removed in continuity with the involved lobe to preserve distal parenchyma. Current controversies relate to indication and safety of the procedure, adequacy as a cancer operation, and contribution of the reimplanted lobe to overall remaining lung function. Between 1975 and 1985, sleeve lobectomy was done electively in 72 patients with lung cancer. There were no operative deaths, but major complications occurred in 10% of patients. Most resected carcinomas were squamous (65/72). Complete resection was performed in all but five patients. A minimum of 1 year's follow-up information was available for all patients. For patients with N0 disease (n = 34) the cumulative 5 year survival rate was 67%, and for patients with N1 status (n = 34) it was 60%. Although postoperative pulmonary function studies at 5 years (n = 19) show subnormal values, they were not severely altered with regard to percent of predicted (forced vital capacity, 85.9% +/- 17.5%; forced expiratory volume in 1 second, 74.9% +/- 19.4%). Regional function was determined by ventilation/perfusion isotope scanning methods. For 15 patients with right lung bronchoplasties, perfusion ratios were 41.1% right lung/58.9% left lung. For four patients with left sleeve operations, these ratios were 29.3% left lung/51.7% right lung. Washout curves show comparable ventilation between the reimplanted lobe and the contralateral lung. The data show that sleeve lobectomy is a safe and adequate operation for patients with resectable lung cancer. The reimplanted lobe or lobes contribute significantly to the overall remaining lung function.     

Second primary lung cancer after bronchial sleeve resection. Treatment and results in eleven patients.

During the years 1960 to 1989, 145 patients underwent sleeve lobectomy or sleeve resection of a main bronchus. Follow-up was complete except for one patient, who was no longer available for follow-up 4 years after operation. Eleven patients (7.6%) had a second primary cancer in the lung; 10 of these patients (90.9%) were men. Mean age at sleeve operation was 61.2 +/- 11.6 years. Mean interval between sleeve operation and development of second primary cancer was 53.8 months (range, 6 to 197 months). All second primary cancers occurred on the contralateral side. In five cases there was squamous cell carcinoma, in two there was adenocarcinoma, in one there was adenosquamous carcinoma, in two there was small cell carcinoma, and in one patient no definite histologic type could be established. Five patients had different histologic type from the initial, resected primary tumor. Seven patients (64%) were operated on: five underwent lobectomy and two underwent segmentectomy. In one patient the tumor was judged to be unresectable. Chemotherapy was given to the two patients with small cell carcinoma and radiotherapy was given to one patient with bone metastases. Follow-up was complete for these 11 patients. Data were calculated from detection of second primary cancer. There was one postoperative death from myocardial infarction. Eight other patients died during follow-up: five died of recurrent tumor or metastases, two died of acute cardiac failure, and one died of a perforated ulcer. The 1- and 4-year actuarial survivals were 41% and 30%, respectively. For the patients operated on, 1- and 4-year survivals were 57% and 43%, respectively. There were no survivors at 5 years. Sleeve resection is a valuable method of preserving functional lung tissue. It offers a chance of subsequent resection in patients who have second primary cancer, with acceptable results.     

Management of acute empyema with leakage of bronchial anastomosis after right sleeve upper lobectomy--a case report

Bronchopleural fistula developing empyema after pulmonary resection is a fatal complication. But we have successfully treated this complication after right sleeve upper lobectomy. The patient was a 61-year-old male, who has a squamous cell carcinoma originating in the right upper lobe of the lung in the clinical stage of IIIa. Right sleeve upper lobectomy with pericardiotomy to reduce the tension of bronchial anastomosis and R2a lymph node dissection. The leakage of bronchial anastomosis was complicated on 5th postoperative day and developed aspiration pneumonia of right middle and lower lobe and empyema. Reoperation was done on 7POD and completion pneumonectomy, omentopexy and open window thoracotomy were performed. Then endotracheal tube had been inserted into the left main bronchus and he controlled under respirator. Six weeks after that fistula was cured. Empyema, which caused by methicillin resistant staphylococcus aureus, was cured by open drainage for 2 weeks and closed drainage and irrigation for 14 weeks. He discharged 16 weeks after reoperation.     

Successful pulmonary resection of lung cancer in a patient with partial anomalous pulmonary venous connection: report of a case

A rare case of the potentially grave combination of lung cancer and partial anomalous pulmonary venous connection (PAPVC) is described. PAPVC would cause many problems following major lung resection, even in a preoperatively asymptomatic patient, because of the inevitable development of right ventricular failure as a result of right ventricular volume overload caused by the left-to-right physiologic shunt. On the other hand, if a patient has primary lung cancer, anatomical resection should be done to achieve curative treatment. We successfully performed a left lower lobectomy for lung cancer in a patient with abnormal venous drainage in the left upper lobe, with simultaneous correction of a PAPVC. Received: August 17, 2001 / Accepted: March 5, 2002     

Reconstruction of the trachea, carina and bronchi

In the past 30 years to March 1985, at Keio University Hospital, 72 tracheal reconstructions, 7 carinal reconstructions, 5 sleeve pneumonectomies and 75 bronchial reconstructions were performed. One patient underwent right upper sleeve lobectomy and sleeve resection of the anterior basal segment of the left lower lobe, both for squamous cell carcinoma. Without these sophisticated procedures and if conventional operation had been performed, right pneumonectomy and left lower lobectomy would have been required in this patient. With the application of bronchoplastic operation this patient could maintain fair lung function for daily life. Although rate of postoperative complications in tracheobronchial reconstruction can not be negligible, appropriate adoption of this procedure with skillness will improve postoperative result.     

Extended operation for lung cancer invading the aortic arch and superior vena cava

Extended operation for lung cancer and mediastinal carcinoma involving the aortic arch or superior vena cava was performed in six patients. In three patients with lung cancer invading the right side of the mediastinum, sleeve pneumonectomy (two patients) or sleeve lobectomy was followed by resection and reconstruction of the superior vena cava with ringed polytetrafluoroethylene grafts. One patient with squamous cell carcinoma and T4 N1 M0 disease was alive and free of disease more than 34 months after the operation. The other patients with adenocarcinoma (T4 N1 M0) and adenosquamous cell carcinoma (T4 N2 M0) died 18 and 5 months after the operation of systemic metastases. In two patients with invasion of lung cancer into the left side of the mediastinum, resection and reconstruction of the aortic arch and left common carotid artery were performed by a femoro-femoral bypass. These patients had adenocarcinoma (T4 N2 M0) and large cell carcinoma (T4 N1 M0) and died of systemic metastases and bleeding during reoperation 12 and 4 months after the initial operation. In one patient with mediastinal squamous cell carcinoma, resection and reconstruction of the aortic arch and left subclavian artery were performed by application of a temporary bypass graft between the ascending and descending aorta. This patient was alive and free of disease more than 17 months after the operation.     

Extended sleeve lobectomy for interlobar lymph node metastasis invading the bronchus from peripheral lung cancer

Although extended sleeve lobectomy has been used as an alternative to pneumonectomy for the treatment of centrally located lung cancer, the validity of this surgical procedure is unclear in patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus. We herein report four patients with peripheral lung cancer in the left lower lobe who underwent extended sleeve lobectomy consequent to interlobar lymph node metastasis. The tumor and metastasized lymph node was extirpated en bloc with division of the main bronchus and upper division bronchus, and those bronchi were anastomosed using the telescope method. All patients were doing well without recurrence. Extended sleeve lobectomy may be applicable to patients with peripheral lung cancer with interlobar lymph node metastasis invading the bronchus to avoid pneumonectomy.     

全胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌120例

目的探讨胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌的安全性、有效性。方法2016年4月~2019年8月我院行胸腔镜支气管袖式/成形肺叶切除治疗中央型肺癌120例,采用三孔法,先行系统性淋巴结清扫,然后行解剖性肺叶切除,最后行支气管切除吻合。结果110例完成全胸腔镜支气管袖式/成形肺叶切除(支气管袖式切除86例,支气管楔形切除成形24例);10例中转开胸(8.3%):肺门叶间淋巴结钙化4例,肿瘤侵犯肺动脉干4例(2例中转为左全肺切除),术中大出血2例。手术时间115~440 min,中位数210 min;出血量50~1000 ml,中位数200 ml。术后平均带管5.8 d(2~34 d),平均住院6.6 d(3~35 d)。术后病理:非小细胞不明类型肺癌2例,鳞癌91例,腺癌13例,混合癌3例(鳞癌为主),神经内分泌癌2例,腺样囊性癌、肉瘤样癌、类癌、肺母细胞瘤、黏液表皮样癌各1例,小细胞肺癌4例。无围手术期死亡,3级以上并发症(Clavien分级)11例(9.2%),包括肺部感染支气管镜吸痰4例(2例呼吸衰竭经历ICU过渡治疗),胸壁皮下气肿行胸腔闭式引流6例,支气管吻合口漏二次手术1例。新辅助化疗后19例中,2例发生3级以上术后并发症(均为皮下气肿置管引流)。113例随访1~41个月,中位随访时间20个月,非肿瘤死亡1例,全身广泛转移死亡11例,Kaplan-Meier生存分析1、2、3年累积生存率分别是98.9%、90.7%、85.4%。结论全胸腔镜支气管袖式/成形肺叶切除治疗包含部分局部晚期的中央型肺癌安全有效,新辅助化疗不额外增加手术风险,值得临床推广。     

Multiple primary lung cancer diagnosed by thoracic computed tomography; report of 2 cases

Two cases of bilateral multiple primary lung cancers are presented. One is synchronous, and another is metachronous. Case 1: An abnormal shadow in the left lower lobe was found on the chest radiograph of 40-year-old female during a regular check-up. Chest computed tomography (CT) film showed a micronodule in the right S2. Left lower lobectomy was performed, followed by second-staged right S2 segmentectomy 1 month after the initial operation. Case 2: A 62-year-old female underwent left lower lobectomy for lung cancer in April 1997. Follow-up CT showed a nodule in right S8. In March 2000, right basal segmentectomy was performed for second lung cancer. Moreover, follow-up CT showed a nodule in right S3. Right wedge resection was performed for third lung cancer in July 2002. It is important to carefully examine a synchronous lesion before the operation of a primary lung cancer and to perform close follow-up surveillance for early detection of a metachronous lesion.     

累及气管下段右侧壁和上腔静脉的右上肺癌的外科治疗

目的：探讨累及气管下段右侧壁和上腔静脉的右上肺癌外科治疗策略及其疗效。方法累及气管下段右侧壁和上腔静脉的T4期肺癌外科治疗患者4例,采用“左主支气管延长”法气道重建,2例采用腔外分流法置换上腔静脉,2例行上腔静脉侧壁切除术。1例同时行肺动脉侧壁部分切除术。结果4例患者均顺利完成手术,无围手术期死亡。术后均给予低分子肝素抗凝治疗2周,之后改为阿司匹林抗凝治疗。术后声音嘶哑合并肺部感染1例,1例房颤。无其他严重并发症,术前上腔静脉阻塞综合征的2例患者术后无上腔静脉阻塞表现,胸部增强CT提示上腔静脉通畅。2例患者分别生存34个月和36个月,仍在随访中;另2例术后病理N2的患者分别生存30个月和31个月,已死亡。结论左主支气管根部延长术和腔外分流法上腔静脉置换或侧壁切除用于治疗累及气管下段右侧壁和上腔静脉的右上肺癌,安全有效。     

应用自体肺移植技术治疗上中中心型肺癌

目的 探讨应用自体肺移植技术治疗上叶中中的可行性。方法 ２例作双袖状右上中叶联合肺叶切除,因支气管切除过和戒肺动脉切除过长,吻合张力过大,做下肺静脉切断,肺短时间离体后作下叶重植,将下肺静脉移下于上肺静残端。２例右上叶肺主斜裂,无法进行双袖状肺叶切除术,行全肺切除后,在器械台上行肿瘤切除,下叶修剪后重植于胸腔内。结果 随访至１９９９年１２月,第１、３、４例患者已分别无瘤存活３１、１８和１３个月。第     

A completion sleeve bilobectomy for nonstump postlobectomy bronchopleural fistula

We present a novel approach for treatment of nonstump postlobectomy bronchial fistula. Our patient had right lower lobectomy for T3 N2 M0 adenocarcinoma. An increased air leak developed 8 days later, and bronchoscopy revealed the presence of a bronchial fistula. On reexploration, the bronchial stump was intact, and the membranous part of the bronchus intermedius was sloughed up to the opening of the upper lobe bronchus. A middle lobectomy with sleeve resection of the bronchus intermedius and part of the right main bronchus was performed, and the upper lobe was reanastomosed to the right main bronchus. The patient's postoperative course was uneventful, and follow-up bronchoscopy showed an intact healed anastomosis.     

Successful lung autotransplantation for central non-small-cell lung cancer: report of a case

Non-small-cell lung cancer (NSCLC) confined to the lung is generally treated by surgical resection. The extent of resection is determined by the location of the tumor and the patient’s pulmonary function. This report presents a successful lung autotransplantation in a man with NSCLC that could not tolerate pneumonectomy or sleeve lobectomy. Right upper and middle bilobectomies were performed, the right lower lobe was resected and retrograde perfusion of Raffinose low-potassium dextran solution (4 °C) was administered. The isolated lower lobe was reimplanted by anastomosis of the bronchus, pulmonary artery, and vein. The patient was cancer-free 1 year after the surgery. Lung autotransplantation can therefore be successfully performed for selected patients with central NSCLC.     

Long-term survival after a surgical resection of pulmonary metastases from gastric cancer: Report of a case

We describe a patient who survived for a prolonged period after repeated resections of pulmonary metastases from gastric cancer. A 59-year-old man underwent a distal gastrectomy for gastric cancer. A right middle lobectomy and a left lower lobectomy were performed for metastases from gastric cancer at 34 months and 82 months after the initial gastric resection, respectively. The patient died of cerebral infarction 65 months after the first lung resection, with no further relapse. To our knowledge, long-term survival after resection of pulmonary metastases from gastric cancer has only been reported in 3 patients previously. We herein review the literature and discuss the role of surgery in such patients.