Bronchoplasty for malignant and benign conditions: a retrospective study of 44 cases

Objective: To study the different operative techniques employed, the problems encountered and the outcome in bronchoplastic procedures both during and after surgery. Patients and methods: Forty-four patients with a mean age of 51.6 years (range 15-80 years) underwent bronchoplastic procedures in the period from 1976 to 1998. There were 27 males and 17 females. Forty-two of these had planned surgery. Two trauma patients had emergency surgery. Out of 42 planned operations, 27 suffered from cancer and 15 had benign lesions. Amongst the non-small cell lung cancer (NSCLC) group, the nodal status was N0 in nine patients, N1 in 12 and N2 in six. Bronchial sleeve resection with lobectomy was performed in 24 patients. Six patients had sleeve pneumonectomies. Fourteen others had bronchial sleeve resections without lobectomies, and bronchoplasties for trauma and stricture. Reconstruction was performed in the earlier years with stainless steel wire of 38/40 SS gauge (n = 22), vicryl (n = 4) and prolene (n = 1). More recently, ethibond (n = 18) was routinely used for this purpose. Anaesthesia was maintained via ore-tracheal intubation, interrupted when necessary with a short period of intubation of one or the ether bronchus through the thoracotomy incision. Results: The mean operating theatre time, including the anaesthesia, was 207 min (range 120-375 min). The duration of stay in the high dependency unit (HDU) was no longer than 3 days. Post-operative problems included excessive bronchial secretions and partial atelectasis (one patient requiring therapeutic bronchoscopy), prolonged mechanical ventilation (n = I) and prolonged air leak (n = 1). There was no per-operative, hospital, or 30 day mortality. Four out of 27 cancer patients lived more than 5 years, 12 died between 2 and 5 years, and 11 lived less than 2 years. Conclusions: Whilst bronchoplasties require special anaesthetic techniques and stringent high dependency post-operative care, there is minimal operative morbidity and mortality. Acceptable duration of survival can be expected even in the cancer patients. (C) 2000 Elsevier Science B.V. All rights reserved.