Surgical tactics for benign bronchial and lung tumors

Abstract

Aim: to identify the efficient surgical tactics in case of benign bronchopulmonary tumors taking into account co-morbidities and possibilities of video-assisted thoracic operations.

Materials and methods. Among 133 patients with benign tumors of the lungs and bronchi 128 (96%) had tumors of peripheral localization, 5 (4%)  — of the central one. All patients with peripheral tumors were operated on. Charlson index was used to assess the co-morbidity.

Results. In 120 (90.2%) patients tumors were diagnosed during routine Х-ray examination or casual check-up.6 (4.5%) patients showed clinical symptoms. The average terms of observation of patients with peripheral tumors were 7.8 months (Me — 6, Q1  — 2, Q3 — 7), with the central ones — 13.3 months (Me — 5,Q1 — 3, Q3 — 8). In 4 cases central tumors were removed by endoscopy methods using electroresection and argon plasma coagulation. In one case a stent was inserted. More than 2/3 of patients had co-morbid pathologies. Charlson  index in co-morbid patients was 2.4±1.4, in the group of patients elder than 70 years — 4.8±0.9. All patients with peripheral tumors were operated on. The video thoracoscopy approach was used in 56 (42.1%) patients, thoracotomy  — in 67 (50.4%), video-assisted minithoracotomy — in 6 (4.5%). In 5.2% of cases thoracoscopy was converted to thoracotomy. All peripheral tumors were mesenchymal ones. Post-operative complications developed in 7 (5.5%) patients. There were no mortality.

Conclusion. Peripheral benign tumors of the lungs are asymptomatic and require urgent surgery with an express histology test to rule out lung cancer. Central tumors are mostly removed by endoscopy. Video thoracoscopy is the most efficient method to remove peripheral tumors. Conversion to thoracotomy is usually necessary in case of a small size and deep tumor localization.