Operative approaches for left-sided carinoplasty

Carinoplasty was performed in 42 patients: 7 with wedge pneumonectomy, 15 with sleeve pneumonectomy, 14 with one-stoma-type carinal reconstruction, 5 with montage-type carinal reconstruction, and 1 other. Diagnoses in the 42 patients consisted of lung cancer in 31 (73.8%), tuberculous stenosis in 10 (23.8%), and tracheobronchial injury in 1 (2.4%). The thoracotomy was on the right side for lung cancer in 77.4% and on the left side for tuberculous stenosis in 80.0% (p < 0.01). Left-sided carinoplasty was performed in 14 patients using four approaches: midline thoracotomy in 1, left thoracotomy in 10, midline sternotomy and left thoracotomy in 2, and bilateral thoracotomies in 1. Left wedge or sleeve pneumonectomy, without right thoracotomy, could be done by midline sternotomy and left thoracotomy but with limited tracheal resection. Left one-stoma-type carinoplasty was undertaken, sacrificing one lobe, as an alternative to pneumonectomy, where an approach drawing the carina down to an aortopulmonary window was considered to be preferable to the drawing-up approach.