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Ann Thorac Surg 2005;80:1841-1846
© 2005 The Society of Thoracic Surgeons

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Original article: General thoracic

Resection for Tumors With Carinal Involvement: Technical Aspects, Results, and Prognostic Factors

Thoracic Surgery Unit, Hôtel-Dieu Hospital, Paris, France

Accepted for publication April 22, 2005.

^_* Address correspondence to Dr Regnard, Service de Chirurgie Thoracique, 1 Place du Parvis Notre Dame 75004 Paris, France (Email: jean-francois.regnard{at}htd.ap-hop-paris.fr).

BACKGROUND: Resection of tumors with carinal involvement remains a challenge because of specific problems of operative technique and airway management. We reviewed our experience with carinal resection and studied factors influencing postoperative course and long-term survival.

METHODS: Between 1983 and 2002, 65 patients underwent a carinal resection for non–small-cell lung cancers involving the carina (54 squamous cell carcinomas and 11 adenocarcinomas).

RESULTS: Fifty-eight right sleeve pneumonectomies and 2 left sleeve pneumonectomies were performed. In addition, five tracheocarinal resections with double bronchial reimplantation (no lung resection) were also performed. The intraoperative airway management consisted of high-frequency jet ventilation in 83% of patients and intermittent conventional ventilation through the operative field in the remaining 17% of patients. Operative mortality was 7.7%. Resection was complete in 61 patients. The overall 5-year and 10-year survival rates were 26.5% and 10.6%, respectively. Patients with N0 or N1 disease had a 5-year survival of 38% compared with 5.3% for those with N2 disease (p < 0.01). At multivariate analysis only nodal status (N0, N1 versus N2; p = 0.0046) had a significant impact on long-term survival.

CONCLUSIONS: Carinal resection provides acceptable results in terms of operative mortality and long-term survival rates. Patients should be carefully selected and probably enrolled in a multimodality treatment program in case of anticipated mediastinal lymph node involvement.

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