J.Jpn. Surg. Soc.. 101(7): 503-508, 2000

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Feature topic

TRACHEOBRONCHOPLASTY FOR LUNG CANCER:OPERATIVE INDICATIONS BY LIMITED CATEGORY

Three limited categories of tracheobronchoplasty are applicable in lung cancer patients. A₁ is for patients who would otherwise be inoperable due to the lack of cardiopulmonary reserve. R₁ is for early-stage cancer localized to the hilar bronchus and which aims to preserve lung function by active limited category. R₃ tracheobronchoplasty preserves respiratory function in noncurative cases. The percentage of patients undergoing A₁, R₁, and R₃ tracheobronchoplasty were 14,2%, 16.8% and 4.2%, respectively (35.2% of total patients undergoing bronchoplasty). Of the total patients, 18.9% underwent carinoplasty, and of these only 4 (2.6%) were eligible for the 3 categories of tracheobronchoplasty. Of lung cancer patients who underwent bronchoplsty, A₁ was performed in 12.6%, R₁ in 16.3%, and R₃ in 3.7% (32.6% of the total). The use of bronchoplasty increased from 7.8% to 21.9% of lung cancer surgery after the introduction of dose-intensive induction chemotherapy (DIIC), mainly due to the increase in the use of interlobar techniques (20.5% of the total) in the smaller bronchial lesions present after DIIC. The 5-year survival rates of patients undergoing A₁, R₁, and R₃ tracheobronchoplasty were 59.6%, 64.9%, and 0%, respectively. No anastomotic recurrence was seen in the 32 patients who underwent R₁. Based on these results, trachobronchoplasty increases survival in patients who receive the A₁ category and preserves lobar function in those who receive R₁ and R₃.

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