Carinal resection and reconstruction in surgical treatment of bronchogenic carcinoma with carinal involvement

Carinal resection and reconstruction is technically demanding. The aim of this study is to discuss the clinical value of carinoplasty in the surgical treatment of bronchogenic carcinoma involving carina.

From 1982 to 2006, 41 cases of centrally placed bronchogenic carcinoma invading the carina were treated with carinal resection and reconstruction in our hospital. Among the 41 patients, 25 patients simultaneously underwent additional cardiovascular plasty operations besides carinoplasty. There were 12 different types of carinal resection and reconstruction in our group.

In this group, there was one perioperative death due to anastomotic leakage. This patient died 2 weeks postoperatively. Arrhythmia occurred in 12 patients, atelectasis in eight patients, and pneumonia in five patients. Five patients had to be assisted with mechanical ventilation because of pulmonary function failure. Anastomosis stenoses were found in three patients 3 to 6 months postoperatively and were resolved by stent insertion. Thirty-one patients were diagnosed with tumor recurrences after operations. Progression-free survival was 75.6% at 1 year, 43.9% at 3 years, and 22.0% at 5 years; the overall actuarial survival was 75.6% at 1 year, 46.3% at 3 years, and 26.8% at 5 years. Survival was better in patients with N0-1 disease than those with N2 disease (37.0% versus 7.1% at 5 years).

Carinoplasty for bronchogenic carcinoma involving carina is feasible with acceptable morbidity and mortality if patients are selected carefully. Preoperative evaluation of the mediastinum is crucial for treatment selection.