Experience in carinal resection and reconstruction in the treatment of carinal tumor and bronchogenic carcinoma (A report of 35 cases)

Abstract

To summarize the experience of carinal resection and reconstruction about the surgical technique and perioperative management in the treatment of carinal and stem bronchial tumor and central bronchogenic carcinoma. Eight cases of carinal and stem bronchial tumor and 27 cases of central bronchogenic carcinoma were included in this group, in which the left atrium was invaded in 5 cases. Types of surgery included carinal resection and reconstruction without pulmonary resection in 5 cases, carinal resection and reconstruction plus right upper lobectomy 18 cases, right carinal pneumonectomy 4 cases, left carinal pneumonectomy 4 cases, and carinal resection and recontruction plus left upper lobectomy 4 cases. Five patients underwent additional partial resection of left atrium. There were 11 different modes of carinal resection and reconstruction in this series. There were no operative death and no anastomotic leakage. Pneumonia was seen in 7 patients, impaired pulmonary function in 1 patient and atelectasis of the entire lung in one patient. Patients with carinal or stem bronchial neoplasms lived free of tumor for 17 months to 7 years after operation. The 1-, 3- and 5-year survival rates in patients with central bronchogenic carcinoma were 96.3%, 70.1% and 37.0% respectively. Five patients had survived more than 10 years. Careful preoperative assessment, skillful surgical technique and proper postoperative management combined with appropriate postoperative therapy would be crucial for great reduction of operative death and morbidity of carinal resection and reconstruction, and also helpful for remote outcome.