Circular resection of the left main and upper lobe bronchi with bronchoplasty in a patient with central cancer of the lower lobe of the left lung (clinical case)

This clinical case focuses on the complexity of surgical treatment of patient with central non-small cell carcinoma of the left lung. The minimum standard amount of surgical treatment for our patient is a left pneumonectomy with systematic mediastinal lymph dissection due to the spread of the tumor to the distal part of the left main bronchus. Taking into account the young age (47 years old) of patient, in order to improve the quality of life, we performed organpreserving surgery: lower lobectomy on the left lung with systematic mediastinal lymph dissection, circular resection of the left main bronchus, the left upper lobular bronchus, bronchoplasty with the formation of a circular anastomosis between the left upper lobular and left main bronchus. To prevent the occurrence of bronchopleural fistula, we used a free, unvascularized pleural fat flap from the pericardial part. The postoperative period was uneventful. 30 months after the operation, the patient is observed without tumor recurrence and generalization. Thus, bronchoplastic surgeries make it possible to save the patient more lung parenchyma and improve the quality of life compared to pneumon- and bilobectomies, while remaining a radical method of treating lung cancer, without worsening disease-free survival.