Carinal surgery: Experience of a single center and review of the current literature

Abstract

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. © 2010 Parissis and Young; licensee BioMed Central Ltd.