[Bronchoplastic procedures for the resection of malignant bronchial neoplasms].
BACKGROUND
Bronchoplastic procedures have become established in the treatment of bronchial malignancies. We report our results on 108 operations performed between 1994 and 2001.


METHODS
Bronchial reconstruction techniques (wedge resection, end-to-end-anastomosis, y-sleeve), comorbidity (cardiovascular, respiratory, pulmonary, neoadjuvant chemotherapy, alcoholism), postoperative complications (septic/aseptic, light/severe), histology, tnm-stage and postoperative follow up (days) were recorded prospectively.


RESULTS
The bronchial tree was reconstructed with an end to end anastomosis in 75 cases (69.4%), a y-sleeve in 17 (15.7%) and a wedge resection in 16 (14.8%). In 11 patients (10.2%), an additional angioplasty of the pulmonary artery was performed. The comorbidity rate was 89.8%. A total of 52 patients (49.1%) presented with one or more cardiovascular risk factors and 84 patients (77.8%) with one or more respiratory risk factors. The overall postoperative morbidity was 26.8% and the mortality 5.5%. Aseptic complications were observed in 12 cases (11.1%) with a mortality of 25% while septic complications occurred in 17 patients (15.7%) with a mortality of 17%. Anastomotic fistulas occurred in three patients (2.8%) and pneumonia in 11 (10.2%). Stage I was found in 46 patients (42.6%), 29 (26.8%) had stage II, 21 (19.5%) stage IIIA, five (4.6%) stage IIIB and two had stage IV (1.8%). The follow up period ranged from 64 to 2,654 days (mean 756.42+/-643.46, median 575.0). Seven patients (6.5%) died with no evidence of disease. After 2 years, 65% of all patients were alive, after five years this had dropped to 50%.


CONCLUSIONS
Bronchoplastic procedures are a safe method for the treatment of bronchial malignancies, even in cases with high comorbidity, and should be performed whenever possible.
Hollaus
P H
PH
Thoraxchirurgische Abteilung, Otto Wagner Krankenhaus, Wien, Osterreich,Germany. Peter.Hollaus@PUL.magwien.gv.at
Wurnig
P N
PN
Pridun
N S
NS
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001980:Bronchi / Q000601:surgery*; D001984:Bronchial Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018278:Carcinoma, Neuroendocrine / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate