What Is a Bronchovascular Sleeve Resection?

Bronchovascular sleeve resection is a surgery performed for lung cancer. It is usually performed when the tumor invades the pulmonary artery (the artery carrying blood from the right ventricle of the heart to the lungs for oxygenation), as well as the bronchus. For example, tumors located in the upper left lobe of the lung. The surgery aims to preserve the bronchial blood supply.

A surgery for lung cancer, bronchovascular sleeve resection helps preserve blood supply in the lungs.

During inhalation, air travels through the nose and/or mouth into the trachea (windpipe). The trachea further divides into two tubes called bronchus (bronchi). The bronchi open into the lungs. Within the lungs, the bronchi branch out into smaller tubes called bronchioles. The end of bronchioles opens into little air sacs called alveoli, which aid in gaseous exchange. The alveoli are surrounded by blood vessels, which help exchange gases, oxygen, and carbon dioxide.

Bronchovascular sleeve resection is indicated in:

• The primary tumor involving the ongoing pulmonary artery and the bronchial wall
• Bulky peribronchial and perivascular metastatic nodal disease inseparable from the ongoing pulmonary artery and bronchial wall

Contraindications to bronchovascular sleeve resection are as follows:

• When complete resection is not achievable by bronchovascular sleeve resection
• Metastatic disease to lung (i.e., the lung is not the primary site of cancer)
• Recurrent lung cancer
• Small cell lung cancer
• Metastasis (spread of cancer from the lung to the rest of the body)
• Poor health status

There are a few stages to having a bronchovascular sleeve resection done, including before, during, and after surgery.

Before the surgery

A surgeon takes a detailed history and performs physical examination and may advise the following tests:

• Chest X-ray
• Chest computed tomography scan with intravenous contrast dye
• Positron emission tomography scan
• Magnetic resonance imaging
• Bronchoscopy
• Pulmonary function test
• Lung perfusion quantitation scan 
• Evaluation of surrounding lymph nodes 

During the surgery

The surgery is performed under general anesthesia, and there are various surgical approaches to perform bronchovascular sleeve resection. The choice of technique depends on the extent of the disease and the surgeon’s discretion.

• Traditionally, this technique has been performed through an open thoracotomy (open surgery), because of the complex anatomy of the airway. Open surgery also provides easier access to perform reconstruction.
• Video-assisted thoracic surgery (VATS) has become a popular surgical approach over the past few decades. VATS is less invasive. Small incisions are made on the skin above the chest cavity to insert a thoracoscope (camera with a light source) and surgical instruments. VATS also allows quicker recovery and is associated with lesser postoperative pain than open thoracotomy.
• Robotic-assisted technology is also available to perform bronchovascular sleeve resection.

Following resection of the tumor, the surgeon proceeds to perform bronchial and pulmonary artery reconstruction

After the surgery

Patients are typically monitored in the intensive care unit (ICU) for 24 to 48 hours. Patients require chest physiotherapy. The patient can mobilize within the first 48 hours. Postoperative can be managed with pain killers. Swelling and bruising typically resolve in one to two weeks. The patients typically stay in the hospital for three to seven days after surgery.

Some complications encountered during surgery are:

• Respiratory failure
• Pneumonia (lung infection)
• Bleeding
• Atelectasis (collapse of the lung)
• Cardiac (heart) problems
• Deep vein thrombosis: Blood clot in deep-lying veins
• Pulmonary embolism: Blood clot in the lungs
• Pain and/or infection at the incision site
• Reaction to anesthesia