Ricerc@Sapienza

OBJECTIVES: The advantages of a bronchial sleeve resection are well established. A clear majority of reported cases are of upper lobe sleeve resection. Reimplantation of the upper lobe bronchus after a lower sleeve lobectomy or bilobectomy (the so-called Y-sleeve resection) is infrequent. Related technical peculiarities are the main issues. We present our experience and results in this setting. METHODS: Between 1989 and 2015, we performed 28 Y-sleeve resections of the left lower lobe (n = 18) or right middle and lower lobes (n = 10).

OBJECTIVES: Resection of a long pulmonary artery (PA) segment infiltrated by tumour and reconstruction by conduit interposition or wide patch is a challenging but feasible option to avoid pneumonectomy. Our goal was to report the long-term results of our experience with this type of operation using various techniques and materials. METHODS: Between 1991 and 2015, 24 patients underwent sleeve resection of a long PA segment or extended resection (> 2.5 cm) of 1 aspect of the circumference of the PA associated with lobectomy for centrally located lung cancer.

We have particularly appreciated the interesting letter from Cohen and colleagues (1) with their comments about our recent paper (2). They underline the importance of the use of lung-sparing operations for the treatment of NSCLC in order to avoid pneumonectomy. In particular, the latter authors confirm our suggestion that even a particular and challenging-considered operation such as lower sleeve lobectomy can provide good short and long term results (3-6).

We have read with great interest the letter from Dr. Perentes and colleagues (1) with his comments about our recent paper (2). Dr. Perentes agrees with our results affirming that for the treatment of centrally located lung cancer sleeve lobectomy should be preferred over pneumonectomy even after induction treatment. Our paper included patients undergoing Y sleeve lobectomy after neoadjuvant chemotherapy. Other experiences on sleeve lobectomy after induction treatment, reporting good results have been published (3-5).

Resection and reconstruction of the pulmonary artery (PA), whether associated or not to a
sleeve resection of the bronchus, allows complete resection of centrally located lung cancer, thus avoiding
pneumonectomy. Despite initial concern related to technical difficulties, perioperative management and long
term survival, recent studies showed continuous enhancement of the surgical technique and reconstruction
materials, reduction of the complication rate and improvement in the survival. This allowed this procedure