Carinal resection and sleeve pneumonectomy

Abstract

Carinal resection (CR) and sleeve pneumonectomy (SP) are one of the challenging issues in thoracic surgery and performed rarely. In spite of the knowledge of the technique, the incidence of postoperative complications is higher compared to standard resections. Adequate patient selection, improved anesthetic management, surgical technique and better postoperative management might reduce the rate of postoperative morbidity and mortality.

Sleeve pneumonectomy and carinal resection for management of primary adenoid cystic tumor of the lung with carinal extension: Report of two cases

“…In the two cases described with tracheal, bronchial and carinal involvement, the cardinal symptoms were dyspnea, cough, hemoptysis and recurrent pulmonary infections, in accordance with what is described in literature [ 4 , 6 ].…”

“…The complete resection of the tumor is the cornerstone of management, however the technique used for sleeve pneumonectomy and carinal resection is one of the most challenging procedures in thoracic surgery [ 6 ]. The first successful case of left carinal pneumonectomy was reported in 1969 as management of adenoid cystic carcinoma that emerged from the left main bronchus [ 7 ].…”

Typical carcinoid involving the main carina managed with arterial embolisation, endobronchial resection and ablation, ultimately followed by carinal resection

“…The best established treatment modality for carcinoid tumours is surgery, although carinal tumours may be technically demanding 4. Recently, multimodal intervention with sequenced embolisation and endobronchial resection has been suggested as an alternative in patients where surgery is not possible 5…”

“…They are technically demanding even with careful patient selection 11. Anatomically, challenges faced include dehiscence of the anastomosis site, necrosis, fistulas and granulation tissue 4. Postoperative mortality rates range from 3% to 20%, while morbidity rates range from 11% to 50% following carina resection 4.…”

“…Anatomically, challenges faced include dehiscence of the anastomosis site, necrosis, fistulas and granulation tissue 4. Postoperative mortality rates range from 3% to 20%, while morbidity rates range from 11% to 50% following carina resection 4. The major complication is acute respiratory distress syndrome, reported in up to 20% of cases 12…”