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Ann Thorac Surg 2006;82:1989-1997
© 2006 The Society of Thoracic Surgeons
a Department of General Thoracic Surgery, University of Barcelona, Barcelona, Spain
b Department of Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany
c Department of Thoracic Surgery, Fukuiken Saiseikai Hospital, Fukui City, Japan
d Department of Anesthesiology, Siloah Hospital, Hannover, Germany
e Department of Radiation Oncology, Siloah Hospital, Hannover, Germany
f Information Systems, Statistics, and Management Science, University of Alabama, Tuscaloosa, Alabama
Accepted for publication July 10, 2006.
* Address correspondence to Dr Macchiarini, Department of General Thoracic Surgery, Hospital Clinic of Barcelona, University of Barcelona, 170 Villarel, Barcelona E-30889, Spain (Email: pmacchiarini{at}clinic.ub.es).
Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
BACKGROUND: We present our perioperative management of operable nonsmall-cell lung cancer invading the tracheobronchial bifurcation and the results obtained.
METHODS: Fifty consecutive patients undergoing carinal surgery with radical lymphadenectomy over a 5-year period were studied.
RESULTS: Eighteen patients (36%) were N2 and had chemoradiation (48 ± 6 Gy) preoperatively. Surgery included 34 carinal pneumonectomies (24 right, 10 left), 11 carinal lobectomies (n = 6) or bilobectomies (n = 5), and 5 carinal resections, with (n = 3) and without (n = 2) reconstructions. Patients were ventilated through low tidal volume controlled techniques except during airway resection and reconstruction, during which the apneic (hyper) oxygenation techniques were used. High inspiratory oxygen concentrations, multiple collapse and reexpansions, hypoperfusion of the ipsilateral lung, and fluid overload were avoided. All patients but 1 were extubated in the operating room, 7 ± 5 minutes after skin closure. Operative mortality (less than 30 days) and morbidity were 4% (n = 2) and 37% (n = 18), respectively. All resections but 1 (98%) R1 were complete. The number of resected nodes per patient was 9 ± 2, and 7 (22%) of the 32 patients who had negative preoperative positron emission tomography results had micrometastatic mediastinal nodes. With a median follow-up of 38 months, actuarial 5-year and disease-free survivals were 51% and 47%, respectively. Disease-free survival was significantly affected by endobronchial extension (tracheobronchial angle invasion versus less than 0.5 cm from carina, p = 0.03) and nodal status (N0 versus N1-2, p = 0.02) in the multivariate analysis.
CONCLUSIONS: Preoperative chemoradiation, carinal lobectomy, or left pneumonectomy, and radical lymphadenectomy do not worsen the therapeutic index of carinal surgery. The high incidence of micrometastatic nodes in positron emission tomography–negative patients justifies routine mediastinoscopy and radical lymphadenectomy.
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  A. Gomez-Caro, S. Garcia, J. M. Gimferrer, E. Martinez, D. Sanchez, and P. Macchiarini Blunt Traumatic Bronchial Transection Ann. Thorac. Surg., March 1, 2008; 85(3): 1107 - 1107. [Full Text] [PDF]
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