The development and introduction of reconstructive operations on the bronchi and tracheal bifurcation is one of the most important achievements of thoracic surgery in the treatment of lung cancer. By now a great deal of experience has been accumulated in using these operations in the leading clinics of the world.
OBJECTIVE
To objectively evaluate the efficiency of reconstructive surgery in patients with central lung cancer in order to enhance the efficacy of treatment and to reduce local recurrences, to increase the proportion of organ-sparing operations, to decline the number of inoperable patients, to clarify indications for different types of resection and plastic surgery of the bronchi and tracheal bifurcation, for additional radiotherapy according to tumor extent and other prognostic factors.
MATERIAL AND METHODS
The investigation was based on an analysis of 1424 reconstructive operations made in 1964 to 2019 on the bronchi and tracheal bifurcation in the surgical and combined treatments of central or peripheral lung cancer with centralization. The surgeons performed pneumonectomy with resection and plastic surgery of the tracheal bifurcation in 206 patients, lobectomy or bilobectomy with resection and plastic surgery of the bronchus and tracheal bifurcation in 64, those with circular resection and plastic surgery of the main bronchus in 552, lobectomy with wedge resection of the main or intermediate bronchus in 553, and segmentectomy with wedge resection of the main bronchial bifurcation in 49.
RESULTS
Short-term and long-term results depended on the extent and, accordingly, volume of resection of the lung, bronchi, and tracheal bifurcation. The rate of postoperative complications and deaths was lowest after lobectomy or bilobectomy with wedge resection of the bronchus (8.7% and 0.5%, respectively) and high after pneumonectomy and lobectomy or bilobectomy with resection and reconstruction of the tracheal bifurcation (27.4% and 8.1%). In patients without lymph node metastases and in those with regional lymph node metastases, the 5-year survival rates after lobectomy or bilobectomy with resection and reconstruction of the bronchi, tracheal bifurcation were 61.5±8.7 and 28.3±9.3%, respectively. Additional radiotherapy in the latter group of patients (with N1-2) increased the 5-year survival rates up to 53.0±7.9%. After pneumonectomy with resection and plastic surgery of the tracheal bifurcation, the 5-year survival rates were 16.2±7.6% in patients receiving surgical treatment, 43.3±19.4% in those having combined treatment with preoperative radiation, and 21.4±8.0% in those undergoing postoperative irradiation. The tumor recurrence rate after reconstructive surgery did not exceed 1.1%.
CONCLUSIONS
1. Reconstructive surgery is indicated in most of central lung cancer patients. It expands the possibilities of radical organ-sparing treatment, by improving the quality of life and allowing the treatment of elderly patients with low functional reserves. 2. Combined treatment with additional radiotherapy improves the long-term results of surgical treatment in patients with regional lymph node metastases and in those with Stage III of the disease.
