Carinal resection and reconstruction in surgical treatment of bronchogenic carcinoma with carinal involvement.
BACKGROUND
Carinal resection and reconstruction is technically demanding. The aim of this study is to discuss the clinical value of carinoplasty in the surgical treatment of bronchogenic carcinoma involving carina.


METHODS
From 1982 to 2006, 41 cases of centrally placed bronchogenic carcinoma invading the carina were treated with carinal resection and reconstruction in our hospital. Among the 41 patients, 25 patients simultaneously underwent additional cardiovascular plasty operations besides carinoplasty. There were 12 different types of carinal resection and reconstruction in our group.


RESULTS
In this group, there was one perioperative death due to anastomotic leakage. This patient died 2 weeks postoperatively. Arrhythmia occurred in 12 patients, atelectasis in eight patients, and pneumonia in five patients. Five patients had to be assisted with mechanical ventilation because of pulmonary function failure. Anastomosis stenoses were found in three patients 3 to 6 months postoperatively and were resolved by stent insertion. Thirty-one patients were diagnosed with tumor recurrences after operations. Progression-free survival was 75.6% at 1 year, 43.9% at 3 years, and 22.0% at 5 years; the overall actuarial survival was 75.6% at 1 year, 46.3% at 3 years, and 26.8% at 5 years. Survival was better in patients with N0-1 disease than those with N2 disease (37.0% versus 7.1% at 5 years).


CONCLUSIONS
Carinoplasty for bronchogenic carcinoma involving carina is feasible with acceptable morbidity and mortality if patients are selected carefully. Preoperative evaluation of the mediastinum is crucial for treatment selection.
Jiang
Feng
F
Department of Thoracic Surgery, Cancer Hospital of Jiangsu Province, Cancer Institution of Jiangsu Province, Nanjing, China.
Xu
Lin
L
Yuan
Fangliang
F
Huang
Jianfeng
J
Lu
Xinxin
X
Zhang
Zhi
Z
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002283:Carcinoma, Bronchogenic / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D014132:Trachea / Q000601:surgery*; D014134:Tracheal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome