title: Evaluations of bronchoplasty and pulmonary artery reconstruction for bronchogenic carcinoma.
abstract: OBJECTIVE
  To evaluate the surgical results of bronchovascular reconstruction and the prognostic factors for lung cancer.
  
  
  METHODS
  From 1976 to 1995, 78 patients with a mean age of 55.1 years (range 26-69 years) underwent bronchoplasty for non-small-cell lung cancer (NSCLC) including pulmonary artery (PA) reconstruction in 21 patients. There were 47 right upper lobectomies (60.3%), 24 left upper lobectomies (30.8%), and seven other atypical types of operations (8.9%). The bronchoplasty was a full sleeve in 71 patients, and a bronchial wedge resection in seven. Thirteen PA tangential resections and eight PA sleeve resections were performed. Tissue diagnosis was squamous cell carcinoma in 56 patients, adenocarcinoma in six, adenosquamous carcinoma in ten, neuroendocrine carcinoma in two and others in four. No patient had a microscopically positive bronchial resection margin. The follow up is complete for all patients. Seventy-five patients were statistically analyzed using STATA software. The survival rate was calculated with life table method. Comparisons of the difference of survival rates between groups were made according to the log-rank test.
  
  
  RESULTS
  The operative mortality rate (30 days) was 3.8% (3/78). The prolonged atelectasis necessitating repeated bronchoscopy was the most common major complication which occurred in 12 patients (16%). Tumor recurrence around the anastomotic site confirmed by bronchoscopic biopsy was observed in four patients. The overall survival at 5 and 10 years was 48.9 and 38.8%, respectively. The 5- and 10-year survival for patients with stage I disease were 66.1 and 57.5%, and for patients with stage II were 62.8 and 44.2%, respectively. The 3- and 5-year survivals for patients with stage III were 11.1 and 0%, respectively (P = 0.0000). The 5-year survival rates for those with N0 tumor (n = 36) were 63.3%, 53.6% for those with N1 (n = 26), and with no survivors for N2 (n = 13), respectively (P = 0.0000). The 5- and 10- year survival rates with bronchoplasty (n = 54) were 55.0 and 47.8%, and 33.3 and 16.7% with bronchovascular reconstruction (n = 21), respectively (P = 0.0033). Multivariate analysis showed that long-term results were influenced chiefly by nodal stage among five factors of pT, pN, bronchoplasty with or without PA reconstruction, cell types, and postoperative adjuvants (P = 0.004).
  
  
  CONCLUSIONS
  Any type of lobectomy with bronchial reconstruction is an adequate cancer operation for both compromised and uncompromised patients especially in patients with stages I and II lung cancer with reasonably good results. Sleeve lobectomy with PA reconstruction may finally be indicated in patients considered compromised because of cardiac or respiratory impairment contraindicating pneumonectomy.
authors.affiliation: Department of Thoracic Surgery, Jiangsu Institute of Cancer Research, Baziting 42#, Nanjing 210009, People's Republic of China. fcw@public1.ptt.js.cn
authors.forename: Feng
authors.initials: F
authors.lastname: Chunwei
authors.forename: Wu
authors.initials: W
authors.lastname: Weiji
authors.forename: Zhou
authors.initials: Z
authors.lastname: Xinguan
authors.forename: Ni
authors.initials: N
authors.lastname: Qingzen
authors.forename: Jiang
authors.initials: J
authors.lastname: Xiangmin
authors.forename: Zhang
authors.initials: Z
authors.lastname: Qingzhen
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D001980:Bronchi / Q000601:surgery*; D018196:Carcinoma, Adenosquamous / Q000401:mortality / Q000601:surgery; D002283:Carcinoma, Bronchogenic / Q000401:mortality / Q000601:surgery*; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome