Carinal pneumonectomy: a 36-year experience

Marco Mammana, Pia Ferrigno, Marco Schiavon, Federico Rea

Abstract

Background: Tracheal sleeve pneumonectomy (TSP) is a rare and challenging procedure. In this paper, indications, techniques and outcomes of patients operated in a single centre over a time span of 36 years are presented.
Methods: Hospital records of patients undergoing TSP were retrospectively reviewed. Survival was estimated with the Kaplan-Meier method. Univariable analysis of risk factors for survival was performed with the log-rank test.
Results: Over the study period, we performed 59 right and 4 left tracheal sleeve pneumonectomies. Main indications were squamous cell carcinoma in 44 patients, adenocarcinoma in 10, adenoid cystic carcinoma (ACC) in 7, and other histology in 2. Twenty-three patients received induction chemotherapy. High-frequency jet ventilation (HFJV) was used in 53 cases (84%). Final pathology examination revealed N2 disease in 22 patients and N3 in 1. Resection margins were microscopically infiltrated in 11 patients. Twenty-six patients (41.3%) experienced postoperative complications, while postoperative mortality was 9.5% (6 patients). The 2-, 5- and 10-year overall survival (OS) rates were 52%, 31.6% and 20.9%, respectively. Survival was significantly worse for patients with N2 disease (P<0.001) and better for patients with ACC (P=0.035). Thirty-eight operations were performed between 1982 and 2000, while 25 patients were operated after 2000. No significant survival difference was observed between patients operated in the two periods. Conclusions: Morbidity and mortality rates following TSP remain elevated. Long-term follow-up is determined primarily by N status, and, therefore, accurate preoperative mediastinal staging is fundamental. Meticulous operative technique and attentive postoperative management are the foundation for good surgical results.