Tracheal sleeve pneumonectomy for non small cell lung cancer (NSCLC): short and long-term results in a single institution.
OBJECTIVE
Bronchogenic carcinoma involving the carina or tracheobronchial angle still presents a challenge due to specific problems related to surgical technique and airway management. We reviewed our experience in carinal resection in terms of mortality, morbidity, and long-term survival.


METHODS
Between 1982 and 2005, 49 patients underwent carinal resection: a right tracheal sleeve pneumonectomy was performed in 48 patients and a left tracheal sleeve pneumonectomy in 1 patient. Induction therapy was administered to 19 (39.6%) patients. In all cases, the anastomosis was performed with aid of high-frequency jet ventilation.


RESULTS
Fourteen patients experienced perioperative complications (overall morbidity 28.6%), including 3 who died, for an overall mortality rate of 6.1%. Late empyema occurred in 5 (10.8%) patients. Histology was squamous cell carcinoma in 38 (77.6%) cases, adenocarcinoma in 10 (20.4%), and large-cell carcinoma in 1 (2%). The overall 5- and 10-year survival rates were 27.5 and 12.8%, respectively. Patients without nodal involvement had a significantly better prognosis than N1 and N2 patients (5-year survival: 56, 17, and 0%, respectively; p=0.002), as did patients with squamous histology compared to adenocarcinoma (5-year survival 29.5 and 11%, respectively; p=0.05). Multivariate analysis showed that nodal status was the only independent prognostic factor (p=0.00007).


CONCLUSIONS
Tracheal sleeve pneumonectomy for bronchogenic carcinoma can be accomplished with acceptable mortality and morbidity, providing good long-term results. Nodal involvement seems to be an exclusion criterion for surgery, as it has a poor prognosis. Meticulous anesthetic management and surgical technique guarantee a better postoperative outcome.
Rea
Federico
F
Department of Cardiologic, Thoracic and Vascular Sciences, Division of Thoracic Surgery, University of Padua, Via Giustiniani, 2, 35100 Padua, Italy. federico.rea@unipd.it
Marulli
Giuseppe
G
Schiavon
Marco
M
Zuin
Andrea
A
Hamad
Abdel-Mohsen
AM
Feltracco
Paolo
P
Sartori
Francesco
F
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality*; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D011300:Preoperative Care; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014132:Trachea / Q000473:pathology / Q000601:surgery*