[Carinal Resection with Lung Resection and Perioperative Management]

Area of Science:

• Thoracic Surgery
• Surgical Oncology

Background:

• Carinal resection combined with lung resection is a rare and high-risk surgical procedure.
• High in-hospital mortality rates are associated with carinal reconstruction (6.5%) and sleeve pneumonectomy (16.7%).

Purpose of the Study:

• To describe preoperative evaluation, intraoperative strategies, and postoperative management for carinal resection with right upper lobectomy.
• To share experiences from two complex cases to aid future thoracic surgeons.

Main Methods:

• Case report of carinal resection with right upper lobectomy.
• Detailed description of surgical techniques, including managing bronchial stump mismatch and dealing with adhesions.
• Postoperative management and complication handling.

Main Results:

• Case 1: Successful sleeve right upper lobectomy achieved by simple sutures for anterior cartilage, avoiding complex carinal reconstruction despite bronchial stump mismatch.
• Case 2: Sleeve right pneumonectomy was necessary due to adhesions; however, an anastomotic fistula occurred, leading to a poor outcome.

Conclusions:

• Effective management of bronchial stump caliber mismatch is crucial for successful sleeve resections.
• Complex cases of carinal resection require tailored surgical approaches and careful postoperative monitoring to mitigate risks and complications.