Experiences With the Surgical Resection of the Human Carina, Tracheal Wall, and Contralateral Bronchial Wall in Cases of Right Total Pneumonectomy

Abbott, Osler A.

doi:10.1016/s0096-5588(20)31703-7

Cited by 68 publications

(12 citation statements)

References 4 publications

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“…While clear evidence to support the efficacy of anastomosis wrapping has not been reported, several institutions including ours have routinely performed any anastomosis wrapping after 2000 (3,4,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Our core objective with anastomotic wrapping is to isolate the anastomotic site from the chest cavity with an adequate quantity of vascularized tissue flaps.…”

Section: Discussionmentioning

confidence: 99%

Elucidation of clinicopathological factors associated with improved clinical outcomes for carinal pneumonectomy in T4 non-small cell lung cancer

Waseda¹,

Miyahara²,

Moroga³

et al. 2020

Shanghai Chest

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Background: Surgical resection remains the gold standard of care for localized cancers. We retrospectively evaluated the efficacy and safety of carinal pneumonectomy for T4 non-small cell lung cancer (NSCLC), with a focus on the effect of changes in our treatment strategy on the outcome of the procedure over time at a single institution. Methods:The study population consisted of consecutive patients with T4 NSCLC who underwent carinal pneumonectomy at our facility between the period of January 1993 and December 2016.Results: Sixteen patients who underwent carinal pneumonectomy for T4 NSCLC were enrolled. Seven patients were operated before 2000 (the pre-2000 group) and nine were after 2000 (the post-2000 group).The multimodal oncological approach was more frequently used in the post-2000 group (6 patients, 66.6% in the post-2000 group vs. one patient, 14.3% in the pre-2000 group, P=0.04). Two patients (12.5%), both in the pre-2000 group, showed 30-day mortality. In-hospital mortality was found in four patients (25%), three in the pre-2000 group and one in the post-2000. Nine patients (56.4%) developed major postoperative complications. Overall survival for the entire cohort was 61.4% at 1-year, 54.5% at 3-year, and 39.0% at 5-year. Overall survival for the post-2000 group was 88.9% at 1-year, 77.8% at 3-year, and 51.9% at 5-year.Overall survival for the post-2000 group was significantly superior to that of the pre-2000 group (P=0.04).Univariate and multivariate analysis for clinicopathological factors influencing overall survival demonstrated that the multimodal approach had a significant positive impact (P=0.02). Conclusions:In highly selected patients, carinal pneumonectomy for T4 NSCLC could be performed with acceptable postoperative outcomes and favorable survival outcomes. Multimodal approach including salvage surgery after definitive chemoradiation is likely to be associated with good long-term survival.

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Section: Discussionmentioning

confidence: 99%

Elucidation of clinicopathological factors associated with improved clinical outcomes for carinal pneumonectomy in T4 non-small cell lung cancer

Waseda¹,

Miyahara²,

Moroga³

et al. 2020

Shanghai Chest

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“…Early reports of carinal reconstruction date back to 1950s and 60s, when teams lead by Abbot and Barclay showed that this type of procedures where possible, despite being associated with considerable morbi-mortality (1,2). As a result of those first reports, surgeons seldom performed them.…”

Section: Review Articlementioning

confidence: 99%

Tracheal and carinal resections in the treatment of non-small cell lung cancer: a trend to a minimally invasive approach

Guido-Guerrero¹,

Bolaños-Cubillo²,

García-Pérez³

et al. 2021

Curr Chall Thorac Surg

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Surgical treatment for non-small cell lung cancer (NSCLC) involving trachea and carina is one of the most infrequent and challenging procedures for a thoracic surgeon, requiring careful preoperative assessment, high level management of the airway, advanced surgical technique and appropriate postoperative care. Carinal and tracheal resections with lung sparing, and carinal sleeve pneumonectomy are part of these complex techniques, with a variable rate of morbidity and mortality. To prevent complications, the most important aspect of the technique is for reconstruction to be performed without tension and with a good blood supply. If a complication is suspected, it must be diagnosed at an early stage, and the problem must be handled aggressively to avoid further progression. The majority of cases are performed with an open approach, but under the care of surgeons and anesthesiologists experienced in minimally invasive thoracic procedures, with advanced airway management skills, in high volume referral centers, these procedures can be performed safely with video-assisted thoracic surgery to obtain good postoperative results. In recent years, with the rapid development of uniportal video assisted thoracic surgery (VATS), this approach resulted in shorter postoperative stays, less postoperative pain and faster recovery after surgery, maintaining oncological principles, becoming an excellent alternative for these difficult cases. This article aims to review the specific considerations that involve this kind of tumors, surgical technique and anesthesiology options, and the recent shift to a minimally invasive approach.

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“…The first clinical experience in 1950 was reported by Abbott who repaired a major tracheal defect by transverse closure following extended right pneumonectomy (7); in 1951, Mathey first described the resection of a cylindroma of the main carina and its reconstruction by longitudinal suturing (8). Crafoord et al reported airway reconstruction after right upper tracheal lobectomy by anastomosing the bronchus intermedius to the trachea, in 1954 (9).…”

Section: Historymentioning

confidence: 99%

Carinal resection and reconstruction with extracorporeal membrane oxygenation support

Petrella¹,

Spaggiari²

2021

Curr Chall Thorac Surg

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Resection of the main carina is one of the most complex procedures of airway resection and reconstruction. It is defined as the resection of the tracheo-bronchial bifurcation and can be accomplished with or without pulmonary resection. Carinal pneumonectomy is defined as the removal of the whole lung together with the main carina; it is usually performed on the right side while it is quite uncommon on the opposite side, although feasible in selected cases. The most frequent indication for carinal pneumonectomy (CP) is primary lung cancer with involvement of the carina or the distal trachea. Isolated carinal resection (CR) without pulmonary resection is rarer and it is performed in patients with primary tumors of the distal tract of the trachea or the carinal bifurcation. Cross-field ventilation (CFV) usually provides adequate support to guarantee tissue oxygenation after tracheal transection; however, airway reconstruction can sometimes be very difficult because of the presence of the ventilation tube in the bronchus to be anastomosed.Extracorporeal membrane oxygenation (ECMO) is a cardio-pulmonary system providing cardiac, pulmonary and circulatory support in the case of cardiac and/or respiratory failure. It can temporarily support cardiac and pulmonary functions until they are restored or-in more advanced cases of pulmonary failure-until lung transplant. The veno-venous ECMO (VV ECMO) is an effective alternative to CFV, allowing tissue oxygenation and CO 2 extraction without the need for tubes in the surgical field. Care should be taken when cannulating vessels as well as managing the ECMO flow during the procedure, in order to prevent major complications. In this paper we focus on the more common techniques of CR and the role of the VV ECMO during the procedure.

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Experiences With the Surgical Resection of the Human Carina, Tracheal Wall, and Contralateral Bronchial Wall in Cases of Right Total Pneumonectomy

Cited by 68 publications

References 4 publications

Elucidation of clinicopathological factors associated with improved clinical outcomes for carinal pneumonectomy in T4 non-small cell lung cancer

Elucidation of clinicopathological factors associated with improved clinical outcomes for carinal pneumonectomy in T4 non-small cell lung cancer

Tracheal and carinal resections in the treatment of non-small cell lung cancer: a trend to a minimally invasive approach

Carinal resection and reconstruction with extracorporeal membrane oxygenation support

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