title: Tracheobronchial reconstructions with bronchoplastic closure: an alternative method in treatment of bronchogenic carcinoma involving the carina or tracheobronchial angle.
abstract: OBJECTIVE
  Our objective was to summarize our experience with tracheobronchial reconstructions using bronchoplastic closure for airway defects after noncircumferential resections of bronchogenic carcinoma involving the carina or tracheobronchial angle.
  
  
  METHODS
  From January 1990 to December 2005, all patients who underwent tracheobronchial reconstructions with bronchoplastic closure for bronchogenic carcinoma involving the carina or tracheobronchial angle were included. The clinical data for patients were collected retrospectively, including demographic characteristics, occurrences of postoperative complications, and survival.
  
  
  RESULTS
  A total of 40 patients were eligible, including 23 who had right pneumonectomies, 6 who had right upper lobectomies, and 11 who had left pneumonectomies, associated with lower lateral wall of the trachea resections or with partial carinal resections for centrally localized tumors. The airway defects ranged from 0.5×2 cm to 2×4 cm and involved up to 50% of the airway circumference. Microscopic residual disease was found postoperatively at the bronchial margin in 20% (8/40). Of 40 patients, 2 (5.0%) had pulmonary atelectasis develop, 2 (5.0%) arrhythmia, 2 (5.0%) bronchopleural fistula, and 1 (2.5%) airway stenosis after operation. Thirty-day mortality was 2.5% (1/40). Median survival for 40 patients was 18.5 months with a cumulative survival of 72.2%, 26.6%, and 21.3% at 1, 3, and 5 years, respectively.
  
  
  CONCLUSIONS
  Tracheobronchial reconstruction using bronchoplastic closure might be a reasonable option for closing massive central airway defects for advanced bronchogenic carcinoma involving the tracheobronchial angle or carina, avoiding tracheal sleeve pneumonectomy with limited excision of the lateral wall of the trachea or carina.
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China. awen.he@yahoo.com
authors.forename: Wen-xin
authors.initials: WX
authors.lastname: He
authors.forename: Bing-qiang
authors.initials: BQ
authors.lastname: Han
authors.forename: Ming
authors.initials: M
authors.lastname: Liu
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.forename: Jiang
authors.initials: J
authors.lastname: Fan
authors.forename: Nan
authors.initials: N
authors.lastname: Song
authors.forename: Ge-ning
authors.initials: GN
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001980:Bronchi / Q000601:surgery*; D002283:Carcinoma, Bronchogenic / Q000401:mortality / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016019:Survival Analysis; D014132:Trachea / Q000601:surgery*