Surgical results of carinal reconstruction: an alterative technique for tumors involving the tracheal carina.
BACKGROUND
We developed a novel technique for carinal reconstruction, one of the most challenging procedures and associated with high morbidity and mortality. Here, we review the results of a surgical study utilizing our technique.


METHODS
Between 1989 and 1999, we performed carinal resection and reconstruction on 14 patients using a technique we developed originally. With this method, two thirds of the circumference of the trachea and the left main bronchus are anastomosed first. After one ring of cartilage is trimmed from the remaining one third of the circumference, the right bronchus is anastomosed end to side to this trimmed site.


RESULTS
Carinal resection plus right upper lobectomy was performed in 12 patients and carinal resection plus right upper-middle bilobectomy was performed in 2 patients. Superior vena cava resection was combined in 4 patients. One patient (7.1%) died postoperatively of dehiscence and bronchoarterial fistula. Major anastomotic complications occurred in 4 patients (dehiscence in 1 and stenosis in 3 [28.5%]). One of three stenoses resolved with ballooning, and this patient survived 5 years; however, the remaining 2 patients died of respiratory problems caused by stenosis. Early and late anastomosis-related death occurred in 3 patients (21%). Overall survival was 57.1% at 2 years and 28.5% at 5 years. Survival was better in patients with N0 disease (n = 9) than those with N2 disease (n = 5; 44.4% versus 0% at 5 years, respectively).


CONCLUSIONS
Our technique for carinal reconstruction can be an alternative to other methods if patients are carefully selected. Anastomotic complications are related to high mortality. Positive N2 disease should be considered a potential contraindication to this technique.
Yamamoto
Kazumichi
K
Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan. granada@d3.dion.ne.jp
Miyamoto
Yoshihiro
Y
Ohsumi
Akihiro
A
Imanishi
Naoko
N
Kojima
Fumitsugu
F
D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D014134:Tracheal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*