Carcinoma of the lung: what can be done if the carina is involved?

When carcinoma of the lung invades the carina, it is by definition a stage III lesion and frequently incurable. However, when lymph node invasion does not preclude resection for cure and when there are no other contraindications to such resection, techniques are now available for resection of the carina and primary reconstruction. While tracheal sleeve pneumonectomy is the operation most frequently employed for invasion of the carina by bronchogenic carcinoma that is otherwise operable, occasionally the lower lobe may also be saved. When the carina is involved by a primary neoplasm of the airways, primary resection with carinal reconstruction with or without various amounts of pulmonary resection is clearly indicated when possible.