Bronchoplastic lobectomies for advanced carcinoma: functional changes and survival.

Twenty-five patients underwent "sleeve" or "wedge" lobectomies for bronchogenic carcinoma: 24 squamous cell type and one adenocarcinoma. In 6, the tumor extended to a segmental bronchus (T1) in 15 to a lobar bronchus (T2) and in 4 to a main brochus (T3): 19 were in the right lung, 6 in the left. Eight patients had no lymph node involvement (N0), 10 tumors had spread to hilar nodes (N1), and 7 to mediastinal nodes (N2). There were 11 "sleeve" and 14 "wedge" bronchoplasties. Two patients developed a bronchopleural fistula: one of them died 2 weeks after pneumonectomy, the only death related to the procedure. A third patient had a local recurrence. Plethysmography, bronchospirography and Xe133 gammagraphy were performed in six patients. Lung volumes usually decreased but dynamics were unchanged or even improved after "sleeve" resection. After "wedge" resection all parameters were impaired. Twelve patients have died of cancer after a mean survival time of 16 months. Four of the 10 eligible patients have survived 5 years and more; seven patients are alive less than 5 years.