[Surgery of cancers extending to the carina]

When small and inextensive these tumours are rare and often surgical; when extensive they are usually unresectable. Owing to the late development of dyspnoea and to the frequent normality of thoracic radiography the endoscopic diagnosis is seldom made at an early stage, which explains why these tumours are often regarded as non surgical. In limited forms the best treatment is resection of the carina with or without reconstruction of the tracheal bifurcation, but this surgical procedure is frequently difficult. However, this type of surgery has benefited from modern imaging for the preoperative evaluation, of advances in anaesthesia and ventilation techniques for the operation itself, and from changes in techniques and strategies by medico-surgical teams specialized in pneumology. The results of this surgery are difficult to evaluate due to the absence of published homogeneous series.