[Carinal Resection with Lung Resection and Perioperative Management]

Carinal resection with lung resection is a rare surgical procedure with high risk. In-hospital mortality rates for carinal reconstruction and sleeve pneumonectomy were 6.5% and 16.7%, respectively. Thus, thoracic surgeons need to learn the procedure for patients who need the surgery. This time, we will account for preoperative evaluation, intraoperative advice, and postoperative management in carinal resection with right upper lobectomy presenting 2 cases in our hospital. Case 1 had a high caliber mismatch of bronchial stumps because of partial carinal resection, which was corrected by simple sutures of the anterior cartilage. That allowed us to perform sleeve right upper lobectomy avoiding carinal reconstruction. Case 2 was a case in which lung and bronchial tissue sticking to mediastinum due to obstructive pneumonia prevented us from anastomosing intermediate bronchus to the trachea or left main bronchus. We had to choose sleeve right pneumonectomy, and a fistula on the anastomotic site occurred later resulting in a bad course. We hope our experiences aid future patients who need the carinal resection.