A case of bronchial anastomotic stenosis after right upper sleeve lobectomy treated with silicone stent]

A case treated with silicone stent for bronchial granulomatous stenosis caused by anastomosis after right upper sleeve lobectomy was reported. A 68-year-old man complained of atelectasis of right upper lobe due to squamous cell carcinoma was admitted to our department. We performed right upper sleeve lobectomy. Four weeks after the operation, hemoptysis and dyspnea appeared with developing local empyema. We performed closure of pleural fistula and thoracoplasty, however, did not improve the symptoms. We performed tracheotomy for deteriorating dyspnea. In addition, granulomatous stenosis of bronchial anastomotic site was observed endoscopically. We tried to insert silicone stent into stenotic site. Although, first trial was in failure, we modified the design of the stent and succeeded in fixation of the stent. The airway was completely re-opened and good patency had been maintained for 7 months until his death due to pneumonia.     

A case of squamous cell carcinoma of the lung treated by right sleeve upper lobectomy after photodynamic therapy]

This patient, a 62-year-old female, with squamous cell carcinoma of the lung was inoperable because of poor pulmonary function due to severe bronchial stenosis by a tumor at the orifice of the right main bronchus. As the tumor decreased in size after photodynamic therapy (PDT), the bronchial stenosis decreased and her pulmonary function improved sufficiency to permit surgery. When right upper sleeve lobectomy was performed, only limited peribronchial inflammation related to PDT procedure was detected indicating only slight extrabronchial influence of PDT. This suggests that PDT is a viable adjunct modality in case in which surgery might possible be performed. The patient has a good postoperative course and is alive 18 months after surgery without any evidence of recurrence.     

Surgically treated mucoepidermoid carcinoma in a 6-year-old boy; report of a case

A 6-year-old boy was admitted to our hospital with a history of recurrent obstructive pneumonia and hemoptysis. A chest computed tomography (CT) showed atelectasis in the left lower lobe. Angiograpy, which was performed for the suspicion of pulmonary sequestration, showed no feeding artery and revealed bleeding from the bronchial artery in the left lower lobe. As hemoptysis would not stop, an emergency left lower lobectomy was performed. Macroscopic examination of the resected specimen revealed a mass measuring 20 x 15 x 17 mm in the S8 proximal lung parenchyma, bronchiectasis, and an abscess in the distal lung parenchyma. Histopathologic examination determined the tumor was a mucoepidermoid carcinoma. Immunohistochemical staining revealed some tumor cells were positive for CA 19-9. The child has not had a recurrence 3 years postoperatively.     

Hepatocellular carcinoma in a case of Dubin-Johnson syndrome treated successfully with right extended lobectomy

A 57-year-old man with hepatocellular carcinoma and liver cirrhosis combined with Dubin-Johnson syndrome was successfully treated by extensive right hepatic lobectomy. While the preoperative serum bilirubin levels is one of the criteria in determining the indication for radical hepatic resection, it does not play a decisive role in the case of combined Dubin-Johnson syndrome.     

A case of advanced gallbladder carcinoma of a 77-year-old female successfully resected with extended right hepatic lobectomy with caudate lobectomy and pancreatoduodenectomy

A 77-year-old woman was admitted with obstructive jaundice. US and CT demonstrated a solid mass 2.5cm in diameter in the hepatic hilum. Cholangiography revealed not only severe stenosis of the hilar hepatic duct but also involvement of the right-posterior-inferior-ventral branch and right caudal branch. Angiography showed almost normal appearance except cystic artery. Duodenal invasion was also detected by per oral duodenography. These findings forced to plan extended right hepatic lobectomy with caudate lobectomy and pancreatoduodenectomy for radicality. In spite of the aged and her complications such as DM, hypertension, scoliosis and bradyacusia, liver function was good and she was mentally very active for life. Therefore, planned operation was performed and the suitability of this operation was proved by histological examination. She underwent resection of the abdominal wall for recurrence 8 months after and now alive without the disease 27 months after the first operation. It is stressed that the most suitable operation should be selected conceiving the mode and severity of cancer extension which is revealed by precise preoperative examinations and extended operation may be indicated in even the elderly if various conditions are good.     

Does pleural bronchial wrapping improve wound healing in right sleeve lobectomy?

The effect of bronchial circulation on wound healing at the site of anastomosis after right upper sleeve lobectomy was studied in dogs. In two dogs (Group I), the bronchial arteries were carefully preserved during the sleeve lobectomy. In 16 dogs (Group II), only sleeve lobectomy was performed after all bronchial arteries in the hilum were ligated. In three dogs (Group III), the site of anastomosis was wrapped by a Penrose drain after sleeve lobectomy. In three other dogs (Group IV), the site of anastomosis was wrapped with a free pleural flap after sleeve lobectomy. In another group of 11 dogs (Group V), the anastomotic site was wrapped with a pedicled pleural flap. The dogs in Group I were put to death immediately and bronchial arterial circulation was recognized to consist primarily of systemic arterial blood. In Group II dogs, bronchial arteries distal to the anastomosis filled with pulmonary arterial blood immediately after the sleeve lobectomy. Although the majority of bronchial arteries became filled with systemic arterial blood with time, some vessels were filled with pulmonary arterial blood even 7 days after the sleeve lobectomy. In Group III dogs, wound healing at the site of anastomosis was severely delayed, and 7 days after the sleeve lobectomy the majority of bronchial arteries in the bronchial wall distal to the anastomosis were filled with pulmonary arterial blood. In Group IV dogs, the state of wound healing at the bronchial anastomotic site was similar to that of Group III dogs. In Group V, although the state of wound healing at the anastomosis was relatively good in most of the animals, the pedicled pleural wrap did not significantly improve bronchial circulation over that of Group II.     

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 treatment of bronchial mucoepidermoid carcinoma in an 11-year-old boy by bronchoplasty: Report of a case

We report herein the rare case of an 11-year-old boy in whom mucoepidermoid carcinoma of the right upper lobe bronchus was successfully treated by bronchoplasty. The patient underwent bronchoscopy to investigate the cause of relapsing respiratory infections over the past 2 years, which revealed a tumor at the orifice of the right upper lobe bronchus. Thus, a right upper sleeve lobectomy was effectively carried out, preserving right pulmonary function. The tumor was observed to partially invade the bronchial wall, but not the lung parenchyma. Histological examination confirmed a diagnosis of mucoepidermoid carcinoma, classified as grade 2 by Conlan's classification. The patient has been well and free of recurrence for 3 years postoperatively.     

Bilateral sleeve upper lobectomy for metachronous squamous cell carcinoma of the lung; report of a case

A 67-year-old man admitted to our hospital complaining cough. Bronchoscopic findings showed tumor at inlet of the left upper bronchus. Left upper sleeve lobectomy was performed. Six years 6 months later, he admitted to our hospital. Bronchoscopic findings showed tumor at inlet of the right upper bronchus. Right upper sleeve lobectomy was performed. He received radiation therapy, and discharged from the hospital 2 months after the operation. It is quite a rare case that the tumor lesions, to which bronchoplasty need to be applied, develop at 2 separate locations. This case proves that sleeve lobectomy can be applied to 2 separate locations successfully.     

General anaesthesia for lobectomy in an 8-year-old child with Kartagener's syndrome

Kartagener's syndrome (KGS) is an autosomal recessive disorder characterized by the clinical triad of bronchiectasis, sinusitis and dextrocardia (situs inversus). Reports of general anaesthesia in a child with KGS are rare in medical literature. We describe the case of a young boy who underwent lobectomy under general anaesthesia using a single lumen tube. Anaesthetic implications of this syndrome are mentioned. Key points in the management of anaesthesia in KGS are discussed.     

A case of parenchymal-sparing right mainstem bronchial sleeve resection for carcinoid tumor

Introduction Neuroendocrine tumors are rare bronchial carcinomata often presenting in a central airway. Resection usually includes a sleeve of the bronchus with the underlying lobe. Case report We present a 19-year old male with retro-obstructive pneumonia from a tumor in the right mainstem bronchus. Bronchoscopy showed an obstructive mass confirmed as being a typical carcinoid on biopsy. Sleeve resection of the mainstem bronchus only was successfully performed sparing the entire right lung.

Discussion and conclusion This type of limited tumoral resection should be reserved for carefully selected patients with a low-grade neoplasm without extrabronchial extension and with both tumor-negative lymph nodes and bronchial margins on frozen section.     

Changes in lung lobar volume and bronchial deformity after right upper lobectomy

n = 10) and A2 (n = 10) were control groups and groups B1 (n = 10) and B2 (n = 10) underwent RU lobectomy. Casting material was introduced into the airway and a heart-lung bloc was removed form the thoracic cavity in all groups. In groups A1 and B1, the volume of each lobe of the bilateral lungs was measured, while in groups A2 and B2, bronchial casts were made and the branching angles of the airway were measured. The volume ratio of the right upper lobe (RUL) to the total lung was 12.0 ± 0.4% in group A1; however, after RU lobectomy, the volume ratio of the right middle lobe (RML) to the total lung increased from 8.7 ± 0.6% in group A1 to 13.5 ± 0.8% in group B1. The volume of the left lung also increased from 43.0 ± 0.5% in group A1 to 48.8 ± 1.1% in group B1. The angle between the truncus intermedius and the RML bronchus was significantly smaller in group B2, at 109.0 ± 3.5°, than in group A2, in which it was 138.5 ± 1.7°. The angle between the RML bronchus and the coronal plane was 57.5 ± 2.5° in group A2 and 33.5 ± 3.3° in group B2. Our method of measuring the bronchial branching angle subsequent to RU lobectomy proved useful to illustrate postoperative positional changes and expansion of the remaining lobes. (Received for publication on Oct. 21, 1996; accepted on May 12, 1997)     

Hepatocellular carcinoma associated with precirrhotic primary biliary cirrhosis successfully treated by a right hepatic lobectomy: Report of a case

We report herein the case of a 69-year-old woman in whom hepatocellular carcinoma (HCC) arising in the precirrhotic phase of primary biliary cirrhosis (PBC) was successfully managed by a right hepatic lobectomy. The patient, who had never received a blood transfusion, had a 4-year history of asymptomatic PBC of Scheuer's histological classification stage II. Abdominal computed tomography (CT) revealed a mass measuring 4.0 cm in the right hepatic lobe, and a right hepatic lobectomy was performed in consideration of her good liver function and the deep location of the tumor in the right lobe. The patient has remained well without any evidence of recurrent disease for 4 years since her operation. A review of the literature revealed only two cases of successful partial hepatectomy, but none of major hepatectomy. Most of the reported cases had been treated with transcatheter arterial embolization (TAE) and were associated with poor survival. Our experience of this patient indicates the potential value of hepatectomy as an alternative to TAE in selected patients with resectable disease and good hepatic function.     

Bronchial fibroepithelial polyp completely resected by left upper sleeve lobectomy; report of a case

Cough and fever persisted in a 48-year-old female, and left pneumonia was diagnosed. A polyp-like lesion obstructing the left main bronchial lumen was observed on chest computed tomography (CT) and bronchoscopy. Since the root of the lesion could not be confirmed, treatment through the airway was considered difficult, and surgery was performed. Since continuation of the root of the lesion to the peripheral bronchus of the left superior lobe was observed during surgery, the left superior lobe was resected by sleeve lobectomy. The entire length of the excised lesion was about 8 cm, and the root arose from the bronchial wall of the left B(5) periphery. Pathologically, bronchogenic fibroepithelioma was definitely diagnosed.     

Torsion of right middle lobe after a right upper lobectomy

Lobar torsion after lung resection is a quite rare complication. A 50-year-old woman presented typical features on chest radiographs and CT(computed tomography) scan of lobar torsion after a right upper lobectomy. After emergency lobectomy of right middle lobe, the patient recovered well and discharged 10 days after the second operation.