# Parenchyma-Sparing Bronchial Sleeve Resection in Low-Grade Malignant Diseases

## TL;DR

This study shows that a lung-sparing surgery called bronchial sleeve resection is safe and effective for treating certain low-grade lung tumors, avoiding full lung removal.

## Contribution

The study provides empirical evidence supporting the use of bronchial sleeve resection as a conservative alternative to lobectomy for low-grade endobronchial neoplasms.

## Key findings

- Bronchial sleeve resections were performed in 25 patients with low-grade tumors without removing lung tissue.
- Five-year overall survival was 100%, and disease-free survival was 80%.
- No local recurrences occurred, though three distant recurrences were observed.

## Abstract

The study addresses a gap in current surgical approaches for treating low-grade endobronchial neoplasms. While sleeve and wedge bronchial resections that spare lung parenchyma are theoretically appealing, they are not widely adopted due to limited data. The authors conducted this research to provide evidence supporting the safety, feasibility, and effectiveness of lung-sparing bronchoplastic procedures in treating these tumors. It is a response to the need for more conservative surgical alternatives to standard lobectomy, especially for benign or low-grade malignancies.

Background/Objectives: Sleeve and wedge bronchial resections without removal of lung tissue may represent a surgical option in selected cases of low-grade neoplasms. This study is a retrospective analysis of the surgical technique and the short- and long- term results of bronchial sleeve resections performed in the Department of Thoracic Surgery of Careggi Hospital in Florence, Italy, and in the Department of Thoracic Surgery of Marie Lannelongue Hospital in Plessis Robinson, France. Methods: Between January 2017 and October 2024, 25 patients with low-grade tumors underwent bronchial sleeve resection with total lung-sparing. We collected the preoperative data, surgical techniques, postoperative results and long-term oncologic outcomes. Results: We performed 25 bronchial sleeves which resulted in 20 typical carcinoids (TC), 3 atypical carcinoids (AT) and 2 mucoepidermoid carcinomas. Three patients had R1 resection, and one of them also had N1 disease; a multidisciplinary team opted for a “watch and wait” policy without adjuvant therapies. No local recurrences occurred, although three distant recurrences were observed. The five-year overall survival (OR) rate was 100%; the five-year disease-free survival (DFS) rate was 80%. Conclusions: Bronchoplastic procedures without lung parenchyma resection are an appropriate and feasible technique for selected cases of low-grade endobronchial neoplasms.