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Pneumonectomy with Carinal Sleeve Resection in Patients with Non-Small-Cell Lung Cancer
Dominik Herrmann1, Urim Starova1, Melanie Oggiano1
1Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Herne, Germany.
The Thoracic and Cardiovascular Surgeon
|October 26, 2023
Summary
Carinal sleeve pneumonectomy is a feasible surgical option for advanced non-small-cell lung cancer (NSCLC) and post-pneumonectomy complications, offering reasonable survival outcomes with manageable morbidity and mortality.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Carinal sleeve resection with pneumonectomy is a rare but viable option for locally advanced central non-small-cell lung cancer (NSCLC) involving the carina.
- This complex procedure can also address stump insufficiency or anastomosis dehiscence following prior pneumonectomy or sleeve lobectomy, respectively.
- Evaluating the outcomes of this specialized surgery is crucial for refining treatment strategies in challenging lung cancer cases.
Purpose of the Study:
- To assess the morbidity and long-term survival rates of patients undergoing carinal sleeve pneumonectomy for non-small-cell lung cancer (NSCLC).
- To evaluate the efficacy of this procedure for both curative intent in advanced NSCLC and as a salvage option for postoperative complications.
Main Methods:
- Retrospective analysis of consecutive patients with NSCLC who underwent carinal sleeve pneumonectomy between December 2001 and September 2003.
- Data collected included demographic characteristics, perioperative variables, and long-term survival.
- Patients were categorized into primary sleeve pneumonectomy (pSP) for curative treatment and secondary sleeve pneumonectomy (sSP) for complications.
Main Results:
- Fifty patients underwent carinal sleeve pneumonectomy; 31 for primary treatment (pSP) and 19 for secondary reasons (sSP).
- Complications occurred in 60% of patients, with a 90-day mortality rate of 18%.
- Overall survival was significantly longer for pSP (39.6 months) compared to sSP (24.5 months) (p=0.01); N status did not impact outcomes.
Conclusions:
- Carinal sleeve resection with pneumonectomy is a feasible procedure with acceptable morbidity and mortality rates.
- It represents a reasonable therapeutic choice for carefully selected patients with locally advanced central NSCLC.
- The study supports the role of this complex surgery in managing challenging lung cancer cases and their complications.
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