gms | German Medical Science

Background: Carinal resection of the trachea is a challenging procedure in pulmonary and central airway surgery. There is only a few number of resectable cases with locally advanced malignoma and careful selection of surgical patients is inevitable. Aim of the study was to illustrate common surgical and anesthesiological approaches for carinal sleeve resection and to identify common indications and possible complications.

Materials and methods: 84 patients underwent tracheal sleeve resection between 09/2000 and 10/2014. Clinical data was analyzed retrospectively with focus on individual therapeutic strategies and intra- and perioperative management.

Results: Eighty-four patients (19 female, mean age 58 yrs) underwent surgery for lung cancer involving the carina. All patients but two had an additional pneumonectomy (79 cases right-side). Oxygenation during tracheal reconstruction was facilitated by high-frequency jet ventilation (HFJV) in all patients with no need of emergency cross-field ventilation. Extracorporeal membrane oxygenation (ECMO) was not used during surgery. Thirty-day mortality was 3.5% (n=3). Predominant histology was T3/T4 squamous cell carcinoma. Main surgical complications were empyema (n=7), anastomotic leakage (n=6) and cardiac herniation (n=4). Mean postoperative survival was 38.5 months (3 to 152) for all and 51 months for N0/N1 patients. 22 patients were alive after a mean follow up of 59 months.

Conclusion: Carinal resection can be offered to only less than 1% of all surgical lung cancer cases but long time survival can reach up to 65% for completely resected nodal-negative patients. Intraoperative HFJV supports adequate oxygenation during carinal reconstruction and makes extracorporeal assist dispensable. Severe complications like anastomotic insufficiencies or cardiac herniation occur in less than 10% and can be avoided by close pre- and perioperative interdisciplinary cooperation.