title: [T4 tracheo-bronchial carcinoma: clinical evaluation of 48 sleeve pneumonectomies].
abstract: The aim of the study was to verify the indications for surgery in T4 tracheo-bronchial carcinomas. Forty-eight tracheal-sleeve pneumonectomies for T4 bronchogenic carcinoma were performed in our unit from 1986 to 2003. The patients were 42 males and 6 females. A postero-lateral thoracotomy was preferred (46 right, 2 left). Bronchial reimplantation was performed additionally (tracheal-sleeve lobectomy) in 2 patients on the right side. The morbidity was 25% and the mortality 6.2% (1 acute respiratory distress syndrome, 1 myocardial infarction, 1 anastomotic fistula). Twenty-three cases were sT4N2M0, 14 sT4N1M0, and 11 sT4N0M0. The sT4N2M0 and sT4N1M0 cases were not associated with more than 3 year survival, despite adjuvant therapies; sT4N0M0 squamous cell carcinomas, on the other hand, had > 40% 10-year survival with no adjuvant therapy. Associated prosthetic replacement of the superior vena cava neither affected the risk nor improved the prognosis. Surgery for T4 tracheo-bronchial carcinoma appears feasible for well differentiated sT4N0 squamous cell carcinomas; at more advanced stages this procedure is no more than a dangerous form of palliation.
authors.affiliation: UO Chirurgia Toracica, Azienda Ospedaliera di Verona.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Politi
authors.forename: Paolo
authors.initials: P
authors.lastname: Scanagatta
authors.forename: Anna
authors.initials: A
authors.lastname: Salani
authors.forename: Matteo
authors.initials: M
authors.lastname: Andreani
authors.forename: Flavio
authors.initials: F
authors.lastname: Montinaro
authors.forename: Miguel
authors.initials: M
authors.lastname: Vassallo
authors.forename: Clemente
authors.initials: C
authors.lastname: Crisci
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D001999:Bronchoscopy; D002283:Carcinoma, Bronchogenic / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D013902:Radiography, Thoracic; D018714:Radiotherapy, Adjuvant; D013908:Thoracotomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000601:surgery*