Successful treatment of mucoepidermoid carcinoma in the left main bronchus
© Kawano et al. 2015
Received: 7 April 2015
Accepted: 13 September 2015
Published: 22 September 2015
Here, we report the successful treatment of a 40-year-old man with mucoepidermoid carcinoma that originated in the proximal end of the left main bronchus close to the carina. He underwent wide and deep airway wedge resection, including the distal trachea and part of the carina via left postero-lateral thoracotomy. He has demonstrated neither anatomic complications nor disease recurrence 2 years after the operation.
A low-grade malignant tumor in the large airway is a good indication for one-stoma-type bronchoplasty, which does not necessitate sacrificing of the parenchyma . However, the ideal surgical approach for a tumor involving the carina is controversial. Here, we report a case of a mucoepidermoid carcinoma that originated in the proximal end of the left main bronchus close to the carina that was managed via left postero-lateral thoracotomy.
Low-grade malignant tumors of the bronchial airway are often managed via circumferential or wedge bronchial resection, because they require minimal surgical margins . Such neoplasms that originated in the proximal left bronchus close to the carina and trachea have been the subject of various discussions on surgical approaches. Right thoracotomy and median sternotomy are common approaches for carina resection and reconstruction . Through these approaches, proximal left main bronchial resection extending beyond the carina and trachea would be possible. However, when the lesion exists at the distal end of the left main bronchus, these approaches would cause inadequate margin along the distal resection line and inadequate left hilar lymph node sampling. Left thoracotomy accompanied by encircling of the trachea with traction tape, with or without resection of Botallo’s ligament, would provide better access to the carina and the distal end of the left main bronchus, whereby an excellent operative field for anastomosis and lymph node dissection could be obtained . If needed, left thoracotomy can provide additional distal airway mobility by using the pericardial hilar release technique. Our procedure will be suitable for mucoepidermoid carcinoma but not for adenoid cystic carcinoma, because it extends longitudinally, which often results in additional wide resection.
Knotting inside the airway makes anastomosis easier, especially in cases of a deep operative field. Here, the three knots placed inside of the airway at the anastomotic site did not cause any airway trouble during the postoperative course. This technique would be more reliable in cases of a deep operative field in the mediastinum and in cases of a more complicated anastomosis.
Bronchoplasty without sacrificing of the parenchyma for a low-grade malignant tumor that originated in the main bronchus is an effective operation. However, it is necessary to consider before surgery, such as approaches and surgical procedures.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Lucchi M, Melfi F, Ribechini A, Dini P, Duranti L, Fontanini G, et al. Sleeve and wedge parenchyma-sparing bronchial resections in low-grade neoplasms of the bronchial airway. J Thorac Cardiovasc Surg. 2007;134:373–7.View ArticlePubMedGoogle Scholar
- Bueno R, Wain JC, Wright CD, Moncure AC, Grillo HC, Mathisen DJ. Bronchoplasty in the management of low-grade airway neoplasms and benign bronchial stenoses. Ann Thorac Surg. 1996;62:824–9.View ArticlePubMedGoogle Scholar
- Grillo HC, Mathisen DJ. Primary tracheal tumors: treatment and results. Ann Thorac Surg. 1990;49:69–77.View ArticlePubMedGoogle Scholar
- Newton Jr JR, Grillo HC, Mathisen DJ. Main bronchial sleeve resection with pulmonary conservation. Ann Thorac Surg. 1991;52:1272–80.View ArticlePubMedGoogle Scholar