Left side sleeves

Left bronchial sleeve resection is a particular surgical technique sometimes required for treating lung cancer arising at the origin of a lobar bronchus. In some cases, this technique is required for resecting a neoplastic hilar node infiltrating the upper left bronchus. In some instances, these neoplastic lesions may infiltrate also the pulmonary artery requiring a double sleeve resection (bronchial and arterial) and reconstruction in order to preserve as much lung parenchyma as technically and oncologically possible. Bronchial reconstruction (the anastomosis between the main left bronchus and the left lower bronchus) is performed with two running sutures with a non-absorbable monofilament in order to obtain a telescopic anastomosis. PA can be infiltrated by the tumor to various levels, from partial infiltration to a more extensive and even circumferential involvement. In case of partial involvement, a partial resection with suture of the PA is indicated; in case of extended involvement, the reconstruction of the PA may be made by using pericardial patch, end-to-end anastomosis, or by the interposition of a prosthetic conduit. In this review, we report our experience in treating lung cancer infiltrating the left pulmonary artery and the left upper bronchus requiring a double sleeve resection and reconstruction. We also describe the workup of these patients and we illustrate in details our surgical technique.