Results of surgical resection for tracheobronchial cancer involving the tracheal carina

Abstract

Carinal resection is a technically demanding procedure that is associated with significant morbidity and mortality. We review our experience of carinal resection and analyze its surgical results. Between 1987 and 2004 a total of 35 patients underwent carinal resection for carcinoma involving tracheal carina. Surgical indications are primary non-small-cell lung cancer (NSCLC) in 29 patients, recurrence of NSCLC in 5, and tracheal cancer in 1. Operative procedures were divided into two groups: a reconstruction group (modified montage method in 14, one-stoma type in 2, montage type in 1); and a pneumonectomy group (tracheal sleeve in 10, wedge pneumonectomy in 8). Postoperative complications and survival of the two groups were evaluated. Three patients died postoperatively (8.5%). Major complications were noted in eight patients (22.8%), including three anastomotic stenoses, two pneumonias with respiratory failure, one dehiscence, one cardiac herniation, and one empyema. Six of these eight patients were in the reconstruction group. The overall survival was 42.5% at 2 years and 28.3% at 5 years. In patients with primary NSCLC, 7 of 16 patients with NO disease survived more than 5 years, but all 13 patients with N1 or N2 disease died within 3 years. In the pneumonectomy group, 9 of 13 patients died within 2 years. Carinal resection for tracheobronchial carcinoma is feasible with acceptable morbidity and mortality. Nodal involvement can be a potential contraindication for carinal resection. Careful selection of patients is crucial, especially when pneumonectomy is required.