Carinal surgery: experience of a single center and review of the current literature.
BACKGROUND
To report our experience for the treatment of lung tumors of the right main bronchus (RMB) invading the carina.


METHODS
From February 2000 till January 2007 we have identified 8 cases (1.09%) requiring carinal surgery.Plan of action: Close cooperation with anaesthetics, long flexible ET tube, Right posterolateral thoracotomy, no irrevocable steps until resection guaranteed, mobilization of trachea and main bronchus, division of the trachea & Left main bronchus. Intubate across surgical field. Tailoring for airway size discrepancies, appropriately. Construction of the tracheobronchial anastomosis around the ventilatory tube. Skillfull reintubation, over a long boogie.


RESULTS
Mortality: 12.5% due to ARDS (one patient)Morbidity: anastomotic stenosis requiring stent (one patient). Follow-up 52 +/- 11 months.Recurrences: 2 patients (both with pathological N2 disease on histology).


CONCLUSIONS
Success of carinal surgery depends on careful patient selection, team approach and attention to detail. Patients with N2 disease carry the worst prognosis.
Parissis
Haralabos
H
Cardiothoracic Department, Royal Victoria Hospital, Belfast, Northern Ireland. hparissis@yahoo.co.uk
Young
Vincent
V
D000368:Aged; D000465:Algorithms; D001980:Bronchi / Q000473:pathology / Q000601:surgery*; D001984:Bronchial Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D013908:Thoracotomy; D014132:Trachea / Q000473:pathology / Q000601:surgery*