A plea for conservatism: minimally invasive sleeve resections

In the first episode of the Netflix series ‘The Crown’ Sir Clement Price Thomas [1893–1973] is shown, successfully performing a pneumonectomy on King George VI. What is less known is that he is also accredited to be the first surgeon performing a ‘conservative resection of the bronchial tree’—avoiding a pneumonectomy—in 1947 (1). Bronchial sleeve resections are now frequently used in case of tumours at the origin of the main bronchi, impeding a lobectomy, but without extra-bronchial spread demanding a pneumonectomy (2). A positive N1 node, fixed to a central lobar bronchovascular structure, is the second most common indication.