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Clinical experience with carinal resection

J D Mitchell1, D J Mathisen, C D Wright

  • 1General Thoracic Surgical Unit, Massachusetts General Hospital, Department of Surgery, Harvard Medical School, Boston, Mass 02114, USA.

The Journal of Thoracic and Cardiovascular Surgery
|December 31, 1998
PubMed
Summary
This summary is machine-generated.

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Carinal resection and reconstruction can be performed with acceptable mortality, but careful patient selection is crucial, especially for left carinal pneumonectomy. Anastomotic complications significantly increase patient morbidity and mortality.

Area of Science:

  • Thoracic surgery
  • Surgical oncology
  • Pulmonary medicine

Background:

  • Carinal involvement by pathologic processes presents significant surgical challenges.
  • Limited institutional experience hinders definitive conclusions on indications, morbidity, and mortality for carinal resection.

Purpose of the Study:

  • To evaluate the indications, surgical techniques, and outcomes of carinal resection and reconstruction.
  • To identify predictors of mortality and complications in patients undergoing carinal resection.

Main Methods:

  • A retrospective review of 135 patients undergoing 143 carinal resections (1962-present).
  • Analysis of indications including bronchogenic cancer, other airway neoplasms, and strictures.
  • Detailed examination of various reconstruction techniques and their impact on outcomes.

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Main Results:

  • The operative mortality rate for primary carinal resection was 12.7%, with predictors including mechanical ventilation and anastomotic complications.
  • Left carinal pneumonectomy showed a high operative mortality rate of 31%.
  • Complications occurred in 39% of patients, with anastomotic issues in 17% leading to reintervention or death in 91% of cases.

Conclusions:

  • Carinal resection with primary reconstruction is feasible but requires careful consideration of the underlying pathology and long-term survival prospects.
  • Left carinal pneumonectomy carries a high mortality risk.
  • Minimizing morbidity and mortality hinges on meticulous patient selection, anesthesia, and surgical technique to avoid anastomotic complications.