Resection of tracheal carina for lung cancer. Procedure, complications, and mortality

We studied 20 patients with lung cancer that invaded the tracheal carina who were operated on during a recent 12-year period. Fifteen patients underwent sleeve pneumonectomy, two had pneumonectomy, one had lobectomy with wedge resection of the carina, and two patients had sleeve resection of the carina followed by reconstruction of the carina. There were two patients with postsurgical stage IIIA lung cancer, 15 with stage IIIB, and three with stage IV disease that involved intrapulmonary metastases. However, the operations of 13 patients were curative resections in which the surgical margin was negative for disease. Sleeve pneumonectomy was performed only in the last 3 years of the study period, after we had confirmed the safety and good results of bronchoplastic surgery by our experience of 100 cases of sleeve lobectomy. Hence, the period of follow-up in this group is too short to assess long-term survival. Eleven patients are alive, three died within 1 month after operation (15%), three died in the hospital beyond 1 month after the operation, and three died after discharge from hospital. Nine of the 11 surviving patients have no evidence of disease 1 month to 2 1/2 years after the operation, but two are alive with supraclavicular lymph node metastases. The 1-year and 2-year survival rates for 17 cases (excluding the three operative deaths) were both 59% by the Kaplan-Meier method. Two different methods were used to adjust the difference of calibers of the trachea and the bronchus. The first method involved the shift of the edge of the cartilagonous portion of the bronchus against the edge of the cartilaginous portion of the trachea and the other involved cutting the tracheal wall as a wedge-shaped piece to shorten the diameter of the tracheal caliber. To prevent complications after resection of the tracheal carina in 11 recent cases with sleeve pneumonectomy, anastomoses were protected by a pedicle fat flap nourished by internal thoracic artery and vein. No postoperative complications of anastomoses developed in any of these cases.