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

Abstract

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.

Diagnosis of lung cancer by flexible fiberoptic bronchoscopy: a descriptive study

“…The tracheal location of the tumor lesion was found in an equal proportion in both patients with NSCLC (10%), especially in the distal trachea, and in patients with SCLC (12.5%). Most tracheobronchial tumors affecting the distal trachea and carina have been shown to be NSCLC, especially SCC [ 49 , 4 ]. Impairment of the right main bronchus (RMB) and right lung has been more commonly seen in patients diagnosed with NSCLC compared to diagnosed with SCLC (46.66% vs. 37.5%), while damage to the left main bronchus (LMB) and left lung were noted predominantly in those with SCLC compared to those with NSCLC (50% vs. 43.33%).…”

“…Most often, SCC have had the appearance of polypoid nodular masses that can cause malignant atelectasis of the central respiratory tract [ 4 ]. Endobronchial SCC cause airways obstruction by mass itself leading to pulmonary atelectasis or lobar collapse [ 49 ]. Central SCC was the most common HP type of LC causing cavity [ 72 ].…”