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.