The Surgical Treatment of Bronchial Adenoma

¹ The Department of Surgery, Division of Thoracic Surgery, University of California Medical School and the San Francisco Hospital.

1. Although bronchial adenomata as reported in the literature may be a potentially or actually malignant tumor, our observations indicate that clinically it is benign if treated as a locally invasive, very slow growing, epithelial tumor.

2. Bronchoscopic removal is of value in preparing the patient for pulmonary resection but is not a definitive treatment because it fails to remove the entire tumor in at least 90 per cent of the cases.

3. Late recurrences (after 5 to 10 years) are to be expected following bronchoscopic removal. Failure to recognize and remove such recurrences may lead to progressive destruction of an entire lung.

4. After two or three attempts at bronchoscopic removal, if the patency of the bronchus is not re-established, or if severe hemorrhage occurs, this treatment should be abandoned in favor of pulmonary resection.

5. Ten cases of pulmonary resection are reported with a cure rate of 90 per cent and one surgical death from infection. This death, the first case operated upon, might have been prevented with the prophylactic use of sulfamerazine and penicillin.

6. A technique is described for conservation of the upper lobe applicable to adenomata located in a stem bronchus, and accomplished by combining lobectomy with bronchotomy.

7. Pulmonary resection accomplished a satisfactory result in nine cases and was superior to bronchoscopic removal in treatment of:

(a) bronchoscopically inaccessible and large tumors,

(b) recurrent tumors following bronchoscopic removal,

(c) distal pulmonary suppuration,

(d) involved mediastinal lymph nodes.

8. No metastases have occurred in any of these ten patients, although in three, tumor was left in the pulmonary stump without apparent spread.

9. With modern pre- and postoperative care, intratracheal anesthesia, and surgical technique, pulmonary resection should be urged for the treatment of benign tumors of the lung, especially in view of their low morbidity, good prognosis and low operative mortality.