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LETTER TO THE EDITOR
Year : 2013  |  Volume : 9  |  Issue : 4  |  Page : 760-761

Neoadjuvant bronchoscopic intervention: Bridge to lung parenchyma sparing surgery


1 Department of Lung Care and Sleep Centre, Fortis Hiranandani Hospital,Vashi, Navi Mumbai, Maharashtra, India
2 Department of Surgical Oncology, Fortis Hiranandani Hospital,Vashi, Navi Mumbai, Maharashtra, India

Date of Web Publication11-Feb-2014

Correspondence Address:
Prashant N Chhajed
B/24, Datta Apartments, Ramkrishna Mission Marg, 15th Road, Khar (West), Mumbai - 400 052, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.126497

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How to cite this article:
Kate AH, Shah PS, Shukla NB, Shetty SN, Chhajed PN. Neoadjuvant bronchoscopic intervention: Bridge to lung parenchyma sparing surgery. J Can Res Ther 2013;9:760-1

How to cite this URL:
Kate AH, Shah PS, Shukla NB, Shetty SN, Chhajed PN. Neoadjuvant bronchoscopic intervention: Bridge to lung parenchyma sparing surgery. J Can Res Ther [serial online] 2013 [cited 2019 Dec 15];9:760-1. Available from: http://www.cancerjournal.net/text.asp?2013/9/4/760/126497

Sir,

The role of interventional bronchoscopy with laser, bronchial dilatation or stent insertion is well-established for the palliative treatment of malignant endobronchial lesions as well as for the management of benign central airway lesions. [1],[2] Therapeutic bronchoscopy has also been reported in patients with malignant disease followed by surgery with curative intention. [3] Debulking of central airway obstruction using interventional bronchoscopy is useful to optimize endobronchial staging of lung cancer and may serve as a bridge for elective lung cancer surgery. [4]

A 23-year-old male patient presented with a history of hemoptysis. Bronchoscopy showed mass lesion in right main bronchus just at the carina. Computed tomography of chest suggested the extent of the lesion almost through the length of the right main bronchus. Endobronchial biopsy was reported as low grade carcinoid tumor. Bronchoscopic diode laser was used to debulk the endobronchial component of the tumor. Almost 2 cm of endobronchial tumor was removed bronchoscopically. The distal part of the tumor was firmly adherent to the airway wall. Subsequently, the patient underwent thoracotomy and a bronchotomy was performed. A safe wide excision of the tumor could be achieved and the bronchus was sutured primarily without any compromise on the airway. Post-operatively, patient has an uneventful course and was discharged.

Sleeve resection is commonly undertaken as a parenchyma sparing surgery to remove such endobronchial growths. [5] Our patient would also qualify for a sleeve resection of the entire right main bronchus with reconstruction of the right upper lobe and intermedius bronchus to the trachea. However, bronchoscopic removal of the endobronchial component of the tumor permitted us to convert a complex sleeve resection to a safe wide excision with primary suturing of the bronchus without any compromise on the airway. The current case highlights the value of a neoadjuvant therapeutic bronchoscopic procedure to permit both a lung parenchyma sparing as well as a sleeve resection sparing surgery.

 
 > References Top

1.Herth F, Becker HD, LoCicero J 3 rd , Thurer R, Ernst A. Successful bronchoscopic placement of tracheobronchial stents without fluoroscopy. Chest 2001;119:1910-2.  Back to cited text no. 1
    
2.Chhajed PN, Malouf MA, Tamm M, Spratt P, Glanville AR. Interventional bronchoscopy for the management of airway complications following lung transplantation. Chest 2001;120:1894-9.  Back to cited text no. 2
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3.Chhajed PN, Eberhardt R, Dienemann H, Azzola A, Brutsche MH, Tamm M, et al. Therapeutic bronchoscopy interventions before surgical resection of lung cancer. Ann Thorac Surg 2006;81:1839-43.  Back to cited text no. 3
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4.Daddi G, Puma F, Avenia N, Santoprete S, Casadei S, Urbani M. Resection with curative intent after endoscopic treatment of airway obstruction. Ann Thorac Surg 1998;65:203-7.  Back to cited text no. 4
[PUBMED]    
5.Lausberg HF, Graeter TP, Wendler O, Demertzis S, Ukena D, Schäfers HJ. Bronchial and bronchovascular sleeve resection for treatment of central lung tumors. Ann Thorac Surg 2000;70:367-71.  Back to cited text no. 5
    




 

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