Serkan BAYRAM, Çağatay TEZEL, Serdar EVMAN, Mustafa AKYIL, Volkan BAYSUNGUR, İRFAN YALÇINKAYA

Sol ana bronş tümörüne sağ torakotomi ile izole sleeve rezeksiyon

Trakeobronşial sistemin mukoepidermoid karsinomları, submukozal bezlerden gelişen ve primer tedavisi cerrahi olan malign tümörlerdir. Parankim hasarı yapmamış ve bronş dışına yayılımı yok ise izole parankim koruyucu rezeksiyon yapılabilir. Hastamız, sol ana bronşta yerleşik karinaya bir cm uzaklıktaki polipoid lezyonundan biyopsi ile düşük dereceli mukoepidermoid karsinom tanısı alan bir olguydu. Radyolojik tetkiklerinde sağ alt lobta da minimal FDG tutulum gösteren parankim nodülü saptanması üzerine hem nodülün değerlendirilmesi, hem de proksimal yerleşimli sol ana bronş tümörü nedeniyle; hastaya sağ torakotomi ile girişim planlandı. Parankim nodülü benign olarak bildirilince, hastaya sol ana bronş izole sleeve rezeksiyonu yapıldı. Nadir uygulanan cerrahi rezeksiyon tekniğin, literatür eşliğinde tartışılması amaçlanmıştır

Isolated sleeve resection of left main bronchus tumor through right thoracotomy

Mucoepidermoid carcinomas of the tracheobronchial system is a malignant tumor arising from submucosal glands, and the primary treatment is surgery. Isolated bronchial sleeve resection can be performed if there is no parenchymal damage and/or no invasion outside of the bronchus. The patient with a polypoid lesion one cm from the carina in the left main bronchus, whom biopsy was reported as low-grade mucoepidermoid carcinoma underwent positron emition tomography revealing parenchymal nodule at right lower lobe with minimal FDG uptake with no distant organ and lymph node metastasis. To evaluate the nodule and approach the proximally located tumor in left main brochus; right thoracotomy was planned. When parenchymal nodüle reported as benign, isolated bronchial sleeve resection made to left main bronhus. The rare resection technique discussed with a review of the literature

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Heitmiller RF, Methisen DJ, Ferry JA, et al. Mucoepidermoid lung tumors. Ann Thorac Surg 1989;47:94-9.
Vadasz P, Egervary M. Mucoepidermoid bronchial tumors: a review of 34 operated cases. Eur J Cardiothorac Surg 2000;17:566-9.
Cicutto LC, Chapman KR, Chamberlain D, Dawney GP. Difficult asthma: consider all of the possibilities. Can Respir 2000;7:415-8.
Ishizumi T, Tateishi U, Watanabe SI, et al. 18 FDG- PET/CT imaging of the low grade mucoepidermoid carcinoma of the bronchus. Ann Nucl Med 2007;20:299-302.
Suen HC, Meyers BF, Guthrie T, et al. Favorable results after sleeve lobectomy or bronchoplasty for bronchial malignancies. Ann Thorac Surg 1999;67:1557-62.
Yavuzer S, Yüksel C, Kutlay H. Segmental bronchial sleeve resection: preserving all lung parenchyma for benign/low-grade neoplasms. Ann Thorac Surg. 2010;89:1737-43.
Haralabos Parissis, Vincent Young. Carinal surgery: experience of a single center and review of the current literature. J Cardiothorac Surg. 2010;5:51.
Maruf Şanlı, Bülent Tunçözgür, Ahmet Feridun Işık, et al. Sleeve resection of mucoepidermoid carcinoma in left main bronchus through median sternotomy. Turk Gogus Kalp Dama 2010;18:151-3.