Key result
Resection of the left main bronchus and anastomosis to the left lower lobe bronchus, facilitated by mobilization and downward retraction of the aortic arch, was successfully performed without postoperative stenosis or granuloma.
Case Report (n=1)
Mobilization and retraction of the aortic arch provides adequate exposure for the safe resection and reconstruction of the left main bronchus in cases of recurrent lung cancer.
May enable complex left main bronchus reconstruction via aortic mobilization; hypothesis-generating and requires prospective validation before wider adoption.
A 68-year-old man, who had undergone left upper sleeve lobectomy, had recurrence of lung cancer in the left main bronchus. We resected the left main bronchus and anastomosed the carinal left main bronchus to the left lower lobe bronchus. To expose the full length of the left main bronchus and carina, we mobilized and retracted downward the aortic arch after division of the four upper intercostal arteries. This retraction of the aortic arch permitted good exposure of the left main bronchus and surrounding tissues, where a lesion might be present. This approach also provided adequate exposure for the anastomosis between the carina and left lower lobe bronchus. The patient received 63Gy postoperatively and was discharged. Postoperative bronchoscopy revealed neither stenosis nor granuloma. An angiogram demonstrated no compression of the left pulmonary artery by the aorta. Tomograms showed a slight shift of the carina to the left, probably due to fixation of the left lower lobe bronchus by the aortic arch.
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Suzuki et al. (1988) conducted a case report in Recurrent lung cancer in the left main bronchus (n=1). Resection of the left main bronchus and reconstruction of the bronchial tree with mobilization and downward retraction of the aortic arch was evaluated on Surgical success and postoperative complications. Resection of the left main bronchus and anastomosis to the left lower lobe bronchus, facilitated by mobilization and downward retraction of the aortic arch, was successfully performed without postoperative stenosis or granuloma.
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