Reimplantation of the upper lobe bronchus after lower sleeve lobectomy or bilobectomy: long-term results†

Abstract

A Y-sleeve resection with reimplantation of the upper load bronchus is a technically feasible and oncologically adequate operation.

Pushing the limits in order to avoid pneumonectomy

“…We have read with great interest the letter from Dr. Perentes and colleagues (1) with his comments about our recent paper (2). Dr. Perentes agrees with our results affirming that for the treatment of centrally located lung cancer sleeve lobectomy should be preferred over pneumonectomy even after induction treatment.…”

Is pneumonectomy still necessary?

“…Whilst sleeve lobectomy has been proven to be oncologically equivalent to pneumonectomy, this surgery is known to be technically more challenging than a pneumonectomy. The recent contribution by Maurizi et al (15) adds to the knowledge of the sleeve lobectomy technicalities by sharing interesting long-term results on the so-called "Y-sleeve resection", that is the reimplantation of the upper lobe bronchus after a lower sleeve lobectomy or bilobectomy. This is a relatively infrequent surgical approach with technical difficulties related to reconstruction and risks of postoperative complications.…”

Upper lobe preservation in the treatment of centrally located NSCLC: one more challenge in lung-sparing surgery?

“…The article we comment on (14) is the first to assess specifically the operative and oncological outcome of upper lobe bronchus re-implantation. The team, expert in the domain of parenchyma preservation (15,16), combined under the term of Y-sleeve lobectomy the re-implantation of the upper lobe bronchus after an inferior left lobectomy (SSL) or an inferior right bilobectomy (ESL type D).…”

“…The remaining part of anastomosis is performed using interrupted sutures, and all knots are tied outside. Maurizi et al (14) consider the management of the bronchial axis and the avoidance of bronchus twisting to be the greatest challenges in Y-sleeve lobectomy. We consider that both have to be anticipated at the time of the section of the bronchus, by cutting the main bronchus transversally, and using oblique bronchiotomy for the upper lobe bronchus, respecting the trifurcation of the right upper lobe bronchus and the lingual bifurcation on the left side.…”