Technical Options and Airway Management in Carinal Resections

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Anesthesiology

Background:

• Carinal resections are complex surgical procedures, often indicated for adenoid cystic and bronchogenic carcinomas.
• Limited randomized controlled trials exist due to low incidence and study design challenges.
• Existing data primarily comes from retrospective, single-institutional studies.

Purpose of the Study:

• To review current data on surgical techniques for carinal resections.
• To discuss ventilation strategies crucial for successful anastomosis construction.
• To analyze indications, outcomes, and the role of minimally invasive approaches.

Main Methods:

• Comprehensive review of existing literature on carinal resections.
• Detailed discussion of surgical techniques, approaches, and ventilation methods.
• Inclusion of case experience with extracorporeal membrane oxygenation (ECMO) and crossfield ventilation.

Main Results:

• Literature review covers indications, techniques, ventilation, morbidity/mortality, and 5-year survival.
• Authors present two cases utilizing ECMO and crossfield ventilation.
• Minimally invasive surgery's role in carinal resections is explored.

Conclusions:

• Carinal resections are complex but yield acceptable outcomes in selected patients.
• Close surgeon-anesthesiologist collaboration is vital for anastomosis.
• Advanced airway management, including ECMO, reduces complications and aids airway reconstruction.