Sleeve Resection

Abstract

A sleeve resection is indicated when the tumour is confined to the upper lobe, the vascular structures are accessible as for upper lobectomy but wider bronchial clearance is necessary. The origin of the upper lobe bronchus may be involved, but the main bronchus at its origin and the intermediate bronchus at its termination must be clear of infiltration. Invasion of the pulmonary artery at this level or the presence of involved hilar lymph nodes contra-indicate sleeve resection. Although sleeve resection of the bronchus and sleeve resection of the pulmonary artery has been undertaken, disastrous fistulae may occur, and pneumonectomy is to be preferred if pulmonary function permits. The strict anatomical restrictions necessary for sleeve resection will be encountered from time to time with carcinoma of the bronchus. However, bronchoplastic procedures are of particular value when dealing with carcinoid tumours. These tumours tend to arise from carinae but have limited extension along the bronchial tree.