Experimental Data

The early clinical experience had not provided sufficient information as to how much the reimplanted lung contributes to overall lung function, particularly in the early postoperative period. Yet, sleeve lobectomy is frequently used in patients with a marginal lung reserve, who are sensitive to even temporary loss of function or an important pulmonary arteriovenous shunt. Wood and colleagues compared the standard right upper lobectomy to a sleeve lobectomy in dogs, using differential bronchospirometry, and found that oxygen uptake dropped by an additional 22% immediately after sleeve lobectomy and was maximally depressed after 3 days.35 This difference from standard lobectomy resolved 4 weeks after the procedure. Postoperative ventilation scintigraphy showed a comparable decrease for standard and sleeve resections, but the perfusion scans suggested that the impaired oxygen uptake of reimplanted lobes was due to a transient abnormality in perfusion. The authors concluded that temporary dysfunction after sleeve lobectomy places patients with impaired lung function at increased risk of respiratory failure compared to simple lobectomy. These findings may also explain the unilateral pulmonary edema occasionally observed in the reimplanted lobe.

Sputum retention and atelectasis are not uncommon after sleeve lobectomy. Paul and colleagues found no difference of mucociliary drainage or bronchial mucus consistency in dogs after sleeve lobectomy, whereas auto- and allotransplantation of the lung delayed clearance and increased mucus viscosity.36 Light microscopy showed relative disappearance of bronchial glands and squamous metaplasia peripheral to the anastomosis in all three groups. These findings support the general attitude that patients who undergo sleeve resection should not require any additional preventive measures for sputum retention.

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