Extended bronchoplasty for locally advanced left lower lobe lung cancer: surgical technique and outcomes

Extended bronchoplasty combined with left lower lobectomy plus lingulectomy can be indicated for some locally advanced left lower lobe cancers to avoid pneumonectomy, but its outcome has not been well studied. We retrospectively analysed the surgical outcomes of 10 patients since 2008, when we introduced this procedure. The median age was 67 years (range 42-80). Squamous cell carcinoma was the most common histology. The indication for this procedure was bulky or extranodal metastasis in an interlobar node in 9 patients and massive tumour invasion to the lingula in 1 patient. Bronchoplasty was performed by a sleeve (n = 7) or deep-wedge (n = 3) resection of the left main and superior division bronchi, according to the type of tumour extension. One of the sleeve cases resulted in anastomotic kinking and was converted to left pneumonectomy intraoperatively, but no postoperative morbidity or mortality was observed. Locoregional recurrence was not found with a median follow-up of 31 months (range 13-83). This type of extended bronchoplasty can be a safe alternative to left pneumonectomy for left lower lobe cancers invading an interlobar node or lingula in which R0 resection is difficult by a simple or standard sleeve left lower lobectomy.