Carinal reconstruction for lung cancer and airway tumors: long-term results

Background: Resection and reconstruction of the carina infiltrated by non-small cell lung cancer (NSCLC) or an airway tumor is a technically demanding operation allowing oncologic radical treatment. Hereby we report the results of a 20-year experience from a high-volume center. Methods: Carinal resection was performed in 41 patients for NSCLC (n = 32) or primary airway tumor (n = 9). Right tracheal-sleeve pneumonectomy was performed in 19 patients, left tracheal-sleeve pneumonectomy in 6, isolated carinal resection in 4, and right tracheal-sleeve upper lobectomy in 12. Superior vena cava replacement was required in 8 patients. Extracorporeal membrane oxygenation was used in 4 patients undergoing isolated carinal reconstruction. Nine patients received neoadjuvant chemotherapy. Results: Complete resection (R0) was achieved in 97.5% of patients. Postoperative 30-day mortality was 7.3% (n = 3). The major complication rate was 24.3% (n = 10). There were 7 airway complications, consisting of 2 anastomotic fistulas and 5 anastomotic stenoses requiring dilatation and stenting; other major complications included 1 esophageal-pleural fistula, 1 pneumonia, and 1 pulmonary edema. Among the 32 NSCLC patients, 26 were pathologic stage III, and 6 were pathologic stage II. The recurrence rate was 34.2% (n = 13) and was 41.3% (n = 12) in NSCLC and 11.1% (n = 1) in airway tumors. The 3- and 5-year overall survival (Kaplan-Meier) was 56.1% (NSCLC, 50.8%; airway, 76.2%) and 50.5% (NSCLC, 44.5%; airway, 76.2%), respectively. Disease-free survival was 61.7% (NSCLC, 55.2%; airway, 85.7%) at 3 years and 55.5% (NSCLC, 48.3%; airway, 85.7%) at 5 years. Conclusions: Carinal reconstruction for lung and airway tumors resection is a complex, oncologically reliable procedure allowing good long-term results in adequately selected patients. Wherever possible, these operations should include parenchymal-sparing techniques allowing healthy lung tissue being spared without compromising the radicality of the resection.