Resection for tumors with carinal involvement: technical aspects, results, and prognostic factors.
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.
Regnard
Jean-François
JF
Thoracic Surgery Unit, Hôtel-Dieu Hospital, Paris, France. jean-francois.regnard@htd.ap-hop-paris.fr
Perrotin
Cédric
C
Giovannetti
Riccardo
R
Schussler
Olivier
O
Petino
Antonio
A
Spaggiari
Lorenzo
L
Alifano
Marco
M
Magdeleinat
Pierre
P
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis