Indications and results of sleeve carinal resection

Carinal resection is the most complicated procedure in tracheobronchial surgery. The main aspects of the technique are still debated at the present time. We present our experience of 231 carinal resections with analysis of operative techniques, complications and long-term survival.

Since 1979 we have performed 231 carinal resections. Indications for surgery included lung cancer in 151 cases (65.4%), non-bronchogenic carcinoma in 45 (19.4%), main bronchus fistula with short stump in 25 (10.8%), stenosis of tuberculous and nonspecific etiology in nine (4%), and trauma in one case (0.4%). We have performed 156 right-sided resections (67.5%) and 75 left-sided (32.5%). In 162 cases carinal pneumonectomy was undertaken, carinal resection following pneumonectomy was performed in 28 cases, isolated resection of bronchial bifurcation was performed in 25 cases, and in 15 cases we combined lobectomy and resection of bifurcation. The length of resection extended from one to nine tracheal rings. The operative approach was lateral thoracotomy in 102 cases (44.2%), and sternotomy in 129 (55.8%).

Thirty-seven patients died postoperatively (16%). Complications were observed in 82 patients (35.4%), dominated by anastomotic problems which occurred in 58 cases (25.1%). The most frequent causes of death were respiratory distress syndrome and anastomotic dehiscence (P < 0.05). Mortality and the incidence of complications were significantly correlated to length of resection, laryngeal nerves injury, and mode of intraoperative ventilation.

The feasibility of carinal resection is limited by the patient's functional status and extension of tumor growth. Thorough selection of patients may improve immediate and long-term results.