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J Thorac Cardiovasc Surg 1996;112:117-123
© 1996 Mosby, Inc.

GENERAL THORACIC SURGERY

PULMONARY FUNCTION AND POSTOPERATIVE COMPLICATIONS AFTER WEDGE AND FLAP RECONSTRUCTIONS OF THE MAIN BRONCHUS

From the Departments of Thoracic Surgery, Physiology, and Biostatistics, University Hospital Leiden, and the Departments of Pulmonary Medicine, Nuclear Medicine, and Thoracic Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.

Received for publication Oct. 28, 1994 Accepted for publication Sept. 12, 1995. Address for reprints: H. A. Huysmans, MD, PhD, Thoracic Surgery, University Hospital Leiden, POB g600, 2300 RC Leiden, The Netherlands.

Abstract

Between 1980 and 1989, 8 wedge and 17 flap main bronchoplasties were done in 24 patients (4 carcinoid tumors, 4 benign lesions, 17 carcinomas). Bronchial anastomotic stenoses, pulmonary function, and survival were evaluated. Preoperative ventilation/perfusion scans with preoperative and postoperative spirometry were done in all patients except two who underwent a wedge bronchoplasty. Postoperative bronchoscopy was done in all patients. Follow-up was complete for the patients with carcinoma (N = 17). In the wedge group bronchial anastomotic stenoses occurred in three (38%) of eight patients. All three patients had serious postoperative complications (persistent atelectasis in one, prolonged ventilatory support in two); one patient died and the other two had impaired postoperative pulmonary function. Complete function recovery occurred in only three (38%) of eight patients who underwent wedge bronchoplasty. In the flap group, bronchostenosis occurred in 3 (18%) of 17 patients. The associated complications (mucus retention, minor atelectasis, partial lobar torsion) were mild. Complete pulmonary function recovery occurred in 13 (76%) of 17 patients who had flap bronchoplasty. Actuarial survival, for the patients with carcinoma, was 88%, 47%, and 41% after 1, 3, and 5 years, respectively. The local recurrence rate was 25% (4/16). In our series, flap main bronchoplasties were effective for the resection of bronchial tumors with local involvement of the adjacent main bronchus. Wedge main bronchoplasties, however, were associated with substantial postoperative complications. (J THORAC CARDIOVASC SURG 1996;112:117-23)

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