TY - JOUR AU - Mammana, Marco AU - Ferrigno, Pia AU - Schiavon, Marco AU - Rea, Federico PY - 2019 TI - Carinal pneumonectomy: a 36-year experience JF - Shanghai Chest; Vol 4 (January 2020): Shanghai Chest Y2 - 2019 KW - N2 - 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 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. UR - https://shc.amegroups.org/article/view/5458