Results of carinal sleeve lobectomy and sleeve pneumonectomy for lung carcinoma

Background: This study presents our surgical procedure and results of treatment for nonsmall cell lung cancer invading the carina. Methods: Between June 2002 and March 2009 in our clinic, 15 patients (13 males, 2 females; mean age 56.7 years; range 36 to 68 years) who underwent carinal resection for nonsmall cell lung cancers (11 squamous cell carcinomas, 2 adenocarcinomas, 1 adenosquamous carcinoma and 1 giant cell carcinoma) were included in this study. According to preoperative staging, there was no mediastinal lymph node involvement in all patients. Eleven patients underwent carnal pneumonectomies (10 rights, I left), and four patients had carinal right upper lobectomies performed. The operative approach was lateral thoracotomy in all patients. In addition to carinal resection one underwent partial resection of the vena cava superior, two partial pericardial resection and one patient underwent adrenalectomy for the metastases. Results: Operative mortality and morbidity were 6.6% (n=1) and 33.3% (n=5), respectively. The most common complications were prolonged air leak and empyema. Four patients had positive N(2) nodes, and five patients had positive Ni nodes postoperatively. Mean recurrence free survival period was 40 months (95% CI: 17.2-63.2) and median recurrence free survival period was 12.2 month (95% CI: 9-15,4; CI: confidence interval). Conclusion: Surgical intervention for carcinoma involving the carina is feasible, with acceptable mortality and good survival in selected patients.