ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Kazumichi Yamamoto
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yamamoto, K.
Right arrow Articles by Kojima, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yamamoto, K.
Right arrow Articles by Kojima, F.
Related Collections
Right arrow Trachea and bronchi

Ann Thorac Surg 2007;84:216-220
© 2007 The Society of Thoracic Surgeons

Original Articles: General Thoracic

Surgical Results of Carinal Reconstruction: An Alterative Technique for Tumors Involving the Tracheal Carina

Kazumichi Yamamoto, MDa,*, Yoshihiro Miyamoto, MDa, Akihiro Ohsumi, MDb, Naoko Imanishi, MDa, Fumitsugu Kojima, MDa

a Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
b Department of Thoracic Surgery, Tenri Hospital, Tenri, Japan

Accepted for publication January 22, 2007.

* Address correspondence to Dr Yamamoto, Department of Thoracic Surgery, National Hospital Organization, Himeji Medical Center, Honmachi 68, Himeji, Hyogo, 670-8520, Japan (Email: granada{at}d3.dion.ne.jp).

Background: We developed a novel technique for carinal reconstruction, one of the most challenging procedures and associated with high morbidity and mortality. Here, we review the results of a surgical study utilizing our technique.

Methods: Between 1989 and 1999, we performed carinal resection and reconstruction on 14 patients using a technique we developed originally. With this method, two thirds of the circumference of the trachea and the left main bronchus are anastomosed first. After one ring of cartilage is trimmed from the remaining one third of the circumference, the right bronchus is anastomosed end to side to this trimmed site.

Results: Carinal resection plus right upper lobectomy was performed in 12 patients and carinal resection plus right upper-middle bilobectomy was performed in 2 patients. Superior vena cava resection was combined in 4 patients. One patient (7.1%) died postoperatively of dehiscence and bronchoarterial fistula. Major anastomotic complications occurred in 4 patients (dehiscence in 1 and stenosis in 3 [28.5%]). One of three stenoses resolved with ballooning, and this patient survived 5 years; however, the remaining 2 patients died of respiratory problems caused by stenosis. Early and late anastomosis-related death occurred in 3 patients (21%). Overall survival was 57.1% at 2 years and 28.5% at 5 years. Survival was better in patients with N0 disease (n = 9) than those with N2 disease (n = 5; 44.4% versus 0% at 5 years, respectively).

Conclusions: Our technique for carinal reconstruction can be an alternative to other methods if patients are carefully selected. Anastomotic complications are related to high mortality. Positive N2 disease should be considered a potential contraindication to this technique.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2007 by The Society of Thoracic Surgeons.