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

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.