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Ping C, Liang J, Liu ZY, He J, Zhou JY, Cheng H, Yuan GD. The impact of surgery and age on mortality with primary trachea malignant tumors: a retrospective study based on propensity-score matching analysis. J Cardiothorac Surg 2023; 18:224. [PMID: 37430368 DOI: 10.1186/s13019-023-02340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/03/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE This study aimed to explore the survival significance of surgery and age on the prognosis of patients with primary trachea malignancies. METHODS The entire cohort of 637 patients with primary malignant trachea tumors was used to perform the main analyses. The data of those patients were from a public database. Overall survival (OS) curves were drawn by the Kaplan-Meier method and compared by the Log-rank test. The univariable and multivariable Cox regression analyses calculated the hazard ratio (HR) and 95% confidence interval (CI) for overall mortality. The propensity-score matching analysis was used to reduce the selection bias. RESULTS Age, surgery, histological type, N classification, M classification, marital status, and tumor grading were identified as independent prognostic factors after eliminating confounding factors. The results of the Kaplan-Meier method revealed that patients with age < 65 had a survival advantage over those with age ≥ 65 (HR = 1.908, 95% CI 1.549-2.348, P < 0.001). The 5-year OS rates were 28% and 8% in the group with age < 65 and age ≥ 65, respectively (P < 0.001). Cases with surgery had better survival over patients without surgery (HR = 0.372, 95% CI 0.265-0.522, P < 0.001). Compared with patients who did not undergo operations, patients with surgery had a higher median survival time (20 vs. 174 months). For patients with surgery, young age was considered a survival-promoting factor (HR 2.484; 95% CI 1.238-4.983, P = 0.010). CONCLUSION We suggested that age and surgery were the independent prognostic factors in patients with primary malignant trachea tumors. Besides, age serves as an essential indicator for evaluating the prognosis of postoperative patients.
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Affiliation(s)
- Chen Ping
- Department of Thoracic Surgery, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu Province, 215128, P. R. China
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P. R. China
| | - Jia Liang
- Department of Internal Medicine, Zhabei central hospital, Shanghai, 200070, P. R. China
| | - Zhi-Yuan Liu
- School of Medicine, School of Life Science and Technology, Shanghai Tenth People's Hospital of Tongji University, Tongji University, Shanghai, 200072, P. R. China
| | - Jiang He
- Department of Thoracic Surgery, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu Province, 215128, P. R. China
| | - Ji-Yao Zhou
- Department of Thoracic Surgery, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu Province, 215128, P. R. China
| | - Hao Cheng
- School of Medicine, School of Life Science and Technology, Shanghai Tenth People's Hospital of Tongji University, Tongji University, Shanghai, 200072, P. R. China.
| | - Guang-Da Yuan
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P. R. China.
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Sezen CB, Yaran OV, Metin M. Carinal sleeve resections. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:S8-S20. [PMID: 38344121 PMCID: PMC10852207 DOI: 10.5606/tgkdc.dergisi.2023.24517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/02/2023] [Indexed: 02/21/2024]
Abstract
Carinal resections are frequently performed for carinal tumors. Resection of the carina due to distal tracheal tumors may be required, and the extension of main bronchial tumors to the carina may lead to carinal resection. This is one of the rarely performed operations in thoracic surgery, which is technically challenging and has a high complication rate. In the early series, perioperative mortality rate was reported as 29% and the five-year survival rate as 15%. Due to its technical difficulties and high complication rates, it is performed only in certain centers. In this review, we discuss techniques related to carinal sleeve resection and prognostic factors in the light of literature data.
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Affiliation(s)
- Celal Bugra Sezen
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Onur Volkan Yaran
- Department of Thoracic Surgery, Bayburt State Hospital, Bayburt, Türkiye
| | - Muzaffer Metin
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye
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Pan H, Zou N, Huang J, Tian Y, Jia Y, Zhu H, Gu Z, Jiang L, Yao F, Luo Q. Short- and medium-term outcomes of video-assisted thoracoscopic surgery versus thoracotomy for carinal lung resection combined with carina reconstruction in locally advanced non-small cell lung cancer patients. Thorac Cancer 2023. [PMID: 37127879 DOI: 10.1111/1759-7714.14919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The application of video-assisted thoracoscopic surgery (VATS) for complex carina surgeries in treating non-small cell lung cancer (NSCLC) patients with involved carina is controversial. This study compared short- and medium-term outcomes of VATS versus thoracotomy for carinal lung resection with carina reconstruction in treating locally advanced NSCLC, aiming to assess the potential benefit of VATS over thoracotomy for these patients. METHODS A total of 37 consecutive NSCLC cases receiving VATS (n = 14) or thoracotomy (n = 23) for carinal lung resection with carina reconstruction from 2016 to 2021 were retrospectively identified. Baseline clinicopathological characteristics, perioperative outcomes, and survival profiles were investigated. RESULTS Patients in the VATS and thoracotomy groups had comparable baseline clinicopathological characteristics (all p > 0.050). VATS decreased postoperative drainage volume compared with thoracotomy (1280 [1170-1510] vs. 1795 [1510-1905] mL, p = 0.012). Regarding surgical-related pains, VATS reduced numeric rating scale scores on the postoperative day 1 (4 [3, 4] vs. 5 [4, 5], p = 0.021) and day 2 (3 [3, 4] vs. 5 [3-5], p = 0.023) than thoracotomy. No difference was found between the VATS and thoracotomy groups in other perioperative outcomes, postoperative complications, and assessment of lymph nodes (LNs) and LN stations (all p > 0.050). Moreover, patients in the two groups had comparable 3-year disease-free survival (DFS), overall survival (OS), and recurrence and mortality patterns. Further subgroup and Cox hazards regression analyses also observed no difference in DFS or OS between the two groups. CONCLUSIONS VATS reduced postoperative drainage volume and ameliorated surgical-related pain, and achieved comparable medium-term survival compared to thoracotomy for carinal lung resection with carina reconstruction in treating locally advanced NSCLC.
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Affiliation(s)
- Hanbo Pan
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningyuan Zou
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Huang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Tian
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunxuan Jia
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongda Zhu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zenan Gu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Pulle MV, Puri HV, Asaf BB, Bishnoi S, Gopinath SK, Kumar A. Carinal Resection and Reconstruction for Tracheo-bronchial Neoplasms-Surgical Outcomes of 20 Consecutively Operated Cases. Indian J Surg Oncol 2020; 12:12-21. [PMID: 33814827 DOI: 10.1007/s13193-020-01198-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022] Open
Abstract
Carinal resections for trachea-bronchial neoplasms are technically challenging and have high operative morbidity and mortality. This study examines the clinical experience of carinal resections for various tracheo-bronchial tumors in a dedicated thoracic surgery center. Medical records were retrospectively reviewed from March 2012 to December 2019 to identify all patients who underwent carinal resection. An analysis of demographic characteristics, perioperative variables including complications, was carried out. Perioperative outcome was the primary outcome measure. Twenty carinal resections were performed with a median follow-up of 2.4 years (range 0.5-4.1). Procedures included 8 isolated carinal resections (40%), 6 right carinal pneumonectomy (30%), 1 left carinal pneumonectomy (5%), and 5 carinal right upper sleeve lobectomy (25%). Age of the patients range from 18 to 62 years with 9/11 male-female ratio. Mean duration from symptom onset to diagnosis was 6.1 months. All post-operative complications occurred in 7 (35%) patients. Anastomotic complications occurred in 2 (10%) patients. Out of these, 1 patient was initially managed with stent placement, ultimately requiring pneumonectomy. Post-operative events were significantly higher in group of patients who underwent carinal resection with concomitant pulmonary resection (P = 0.01). No perioperative (90-day) mortality was found. Despite advances in perioperative management, carinal resection poses challenges for both patient and surgeon. Concomitant pulmonary resection was associated with increased risk of peri-operative complications. Appropriate patient selection, meticulous surgical technique, and stringent post-operative protocols are the key for success.
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Affiliation(s)
| | - Harsh Vardhan Puri
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
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Krecmerova M, Schutzner J, Michalek P, Johnson P, Vymazal T. Laryngeal mask for airway management in open tracheal surgery-a retrospective analysis of 54 cases. J Thorac Dis 2018; 10:2567-2572. [PMID: 29997917 DOI: 10.21037/jtd.2018.04.73] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Airway management in tracheal resections presents many challenges. The aim of this retrospective analysis is to report the efficacy and complications associated with the use of the laryngeal mask airway in this procedure. Methods The charts of 54 consecutive patients operated for tracheal stenosis during the period 2009-2016 were reviewed. This cohort included only resections of the trachea. We evaluated total success rate of laryngeal mask insertion (%), insertion success rate on the first attempt, the quality of intraoperative ventilation through the laryngeal mask, the quality of fibre optic view through the device, incidence of bleeding during the first 24 h, signs of dehiscence of the anastomosis within 48 h and 30-day mortality. Results The laryngeal mask airway provided a patent airway throughout the procedure in 52 (96.4%) patients. Insertion of the device failed in 1 (1.8%) patient due to abnormal upper airway anatomy. Another patient (1.8%) developed laryngeal mask malposition during intraoperative neck extension subsequently requiring tracheal intubation. Fibre optic view through the devices including insertion of the flexible bronchoscope was satisfactory in 52 (96.4%) patients. Serious complications, such as pulmonary aspiration, early postoperative bleeding or suture dehiscence were not observed in this cohort. Conclusions Based on this analysis of 54 patients, we would consider the laryngeal mask airway a feasible alternative to the tracheal tube for airway management and ventilation during open tracheal surgery.
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Affiliation(s)
- Martina Krecmerova
- Department of Anaesthesiology and Intensive Care Medicine, 2nd School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
| | - Jan Schutzner
- Department of Surgery, 1st School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
| | - Pavel Michalek
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Paul Johnson
- Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Tomas Vymazal
- Department of Anaesthesiology and Intensive Care Medicine, 2nd School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
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The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review. Can J Anaesth 2018; 65:685-697. [DOI: 10.1007/s12630-018-1099-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 12/15/2022] Open
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Kirschbaum A, Hemmerling S, Steinfeldt T, Bartsch DK, Mirow N. Initial Resistance of Carina Anastomoses with Increasing Tensile Stress: An ex vivo Model Comparing Different Suture Techniques. Eur Surg Res 2016; 58:20-26. [PMID: 27577554 DOI: 10.1159/000447966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/24/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND After resection of the carina with a length of more than 4 cm, anastomoses often need to be performed under tension despite maximum mobilization. If the patient cannot be extubated, the anastomosis remains under continued stress. Anastomoses of the carina can be constructed using various suture techniques, including single interrupted sutures, back wall running but front wall single interrupted sutures, and complete running suture. This experimental study was designed to determine the most tensile stress-resistant anastomotic suture technique. MATERIALS AND METHODS Isolated preparations of tracheobronchial trees were recovered from freshly slaughtered pigs. Resection of the carina was carried out in preparation of the experiments. After blind randomization, anastomoses (n = 15 per group) between the distal trachea and the proximal left main bronchus were performed with PDS 4-0 employing three different suture techniques: (1) single interrupted sutures, (2) back wall running but front wall single interrupted sutures (= mixed technique), and (3) complete running suture. The anastomotic specimen was fixed onto a specially constructed device. The tracheal end was intubated with a tube (CH 8.0) and connected to a respirator. Different weights were attached to the distal end of the preparation via a clamp and guide rollers. Airtightness was investigated at the following tensile loads: 0, 500, 1,000 and 1,500 g. Intrabronchial pressure was increased in 5-mbar steps. In an underwater trial, we analyzed whether anastomoses were airtight at a maximum intrabronchial ventilation pressure of 70 mbar. RESULTS At an intrabronchial pressure of 25 mbar without tensile stress, all anastomoses were initially airtight. In tensionless anastomoses at 70 mbar, 100% of single interrupted and continuous sutures were airtight, as compared to 80% of sutures in mixed technique. At 70 mbar and tensile loads of 1,500 g, 80% of single interrupted sutures, 60% of sutures in mixed technique and 53% of the running sutures remained competent. CONCLUSION If tracheal anastomoses can be performed without tension, the suture technique is not important. With increased tension, anastomoses performed in single interrupted suture technique were clearly superior. Thus, in situations, where high tensile stress is to be expected, single interrupted sutures should be preferred.
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Affiliation(s)
- Andreas Kirschbaum
- Department of Visceral, Thoracic und Vascular Surgery, University of Marburg, Marburg, Germany
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Koo CH, Jung YS, Lee YH, Kim HC, Bahk JH, Seo JH. Severe hypoxemia during carinal resection in the lateral position under one-lung ventilation of a non-dependent lung: a case report. Korean J Anesthesiol 2016; 69:279-82. [PMID: 27274375 PMCID: PMC4891542 DOI: 10.4097/kjae.2016.69.3.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/07/2015] [Accepted: 04/14/2015] [Indexed: 11/18/2022] Open
Abstract
During one-lung ventilation (OLV) in the lateral position, the dependent, ventilated lung receives more blood flow than the non-dependent, non-ventilated lung owing to gravity, improving the match of ventilation and perfusion. Conversely, in the rare clinical situations when OLV is applied to the non-dependent lung, arterial oxygenation can get worse due to considerable shunt flow to the dependent non-ventilated lung. We report a case of severe hypoxemia during carinal resection under OLV of a non-dependent lung. In this case, OLV had to be applied to the non-dependent lung in the lateral position because the bronchus of the non-dependent lung was anastomosed with the trachea, whereas the bronchus of the dependent lung had already been resected for carinal resection. The subsequent hypoxemia resulting from the shunt flow to the dependent non-ventilated lung was treated successfully by ligating the pulmonary artery of the dependent lung.
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Affiliation(s)
- Chang-Hoon Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoo Sun Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Hun Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun-Chang Kim
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong-Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Shin S, Park JS, Shim YM, Kim HJ, Kim J. Carinal resection and reconstruction in thoracic malignancies. J Surg Oncol 2014; 110:239-44. [PMID: 24888321 DOI: 10.1002/jso.23643] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/10/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to present clinical outcomes of malignant tumors involving the carina after surgery in order to establish the management guidelines. METHODS Between 1996 and 2011, 30 patients underwent carinal resection and reconstruction for malignancy involving carina. We retrospectively analyzed their medical records. There were 22 cases of common type of NSCLC (squamous cell carcinoma/adenocarcinoma/large cell neuroendocrine carcinoma) and eight cases of carcinomas of salivary gland type (adenoid cystic carcinoma/mucoepidermoid carcinoma). RESULTS Seventeen right sleeve pneumonectomies, two left sleeve pneumonectomies, nine carinal sleeve right upper lobectomies, and two airway resections and reconstructions without lung resection were performed. There were no in-hospital mortalities. Eleven postoperative morbidities occurred including three cases of acute respiratory distress syndrome following pneumonectomy. Late complications occurred in eight patients including three cases of anastomotic stenosis. During follow-up, 12 mortalities occurred, including 6 cancer-related mortalities. The 5-year overall survival rate (OS) and disease-free survival rate (DFS) were 66.3% and 52.9%, respectively. CONCLUSIONS Malignant tumors involving the carina can be controlled with carinal surgery with acceptable mortality and morbidity. Patients with thoracic malignancy involving the carina should be considered as surgical candidate based on disease extent and functional status.
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Affiliation(s)
- Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Blackney KA, Alfille PH. Anesthetic Management of a Delayed Carinal Resection Following Traumatic Disruption. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojanes.2014.410034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Primary major airway tumors; management and results. Eur J Cardiothorac Surg 2011; 39:749-54. [DOI: 10.1016/j.ejcts.2010.08.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/11/2010] [Accepted: 08/19/2010] [Indexed: 11/21/2022] Open
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Parissis H, Young V. Carinal surgery: experience of a single center and review of the current literature. J Cardiothorac Surg 2010; 5:51. [PMID: 20565903 PMCID: PMC2901221 DOI: 10.1186/1749-8090-5-51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 06/19/2010] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Haralabos Parissis
- Cardiothoracic Department, Royal Victoria Hospital, Belfast, Northern Ireland.
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