Carinal resection

There are many challenges in performing carinal resection and, in particular, reconstruction. A better understanding of the safe limits of resection has contributed to the reduced mortality from anastomotic complications. Accurate selection of patients, a meticulous adherence to surgical precision, and optimal postoperative patient care have become mandatory to reduce the risk of the most serious complications, such as noncardiogenic pulmonary edema and suture dehiscence. With carinal resection for bronchogenic carcinoma, contemporary studies suggest that there are reasonable survival rates in the absence of involved mediastinal lymph nodes or distant metastatic disease. The role of neoadjuvant therapy for bronchogenic carcinoma involving the carina deserves further investigation; this type of therapy should be used with caution because of the deleterious effects on anastomotic healing.