Tracheobronchoplasties in lung cancer

RESUMO

Seventy-four tracheobronchoplastic procedures were analyzed in a population of 990 pulmonary resections performed for lung cancer between 1954 and 1994. Fifty-four tracheobronchoplasties were performed between 1954 and 1977 without clinical staging. A second group of 20 tracheobronchoplastic procedures were carried out between 1978 and 1994 with prospective staging assessment. These were classified according to stage as follows stage I, 5; stage II, 4 and stage III, 11. The overall indidence of bronchial fistula was 13.5 percent (10 cases), nine patients in the 1954-1977 group (16.6 percent) and one (5 percent) in the 1978-1994 period. Local recurrence was detected in 8 patients (13.1 percent) out of 61 postoperative survivors in the whole series. However, this figure was markedly reduced (5 percent) in the second group. Overall postoperative mortality was 17.6 percent (13 patients) and was not different in both groups. Five-year actuarial survival curve reached 21.8 percent in the first group and 21.9 percent in the second group. Tracheal and bronchoplastic techniques are useful procedures that can be safely applied to lung cancer surgery. Indications are the following to extend the limits of resection; to allow resections in limited pulmonary function patients and to perform isolated main stem bronchus or carinal resections.