Abstract
Background Carinal sleeve resection with pneumonectomy is one of the rarest procedures in thoracic
surgery, but for locally advanced central lung cancer with infiltration of the carina,
it is an option to achieve complete resection. Additionally, it might be the method
of choice for patients with stump insufficiency after pneumonectomy or in the cases
with anastomosis dehiscence after sleeve lobectomy. The aim of this study was to evaluate
the morbidity and long-term survival of patients with non-small-cell lung cancer (NSCLC)
who underwent sleeve pneumonectomy, either for curative intent or as an option to
treat postoperative complications.
Methods All consecutive patients with NSCLC who underwent carinal sleeve pneumonectomy for
the aforementioned indications in our department between December 2021 and September
2003 were included in this study. An analysis of demographic characteristics, perioperative
variables, and long-term survival was carried out. Data were evaluated retrospectively.
Results Fifty patients underwent pneumonectomy with carina sleeve resection. Thirty-one cases
for curative treatment of NSCLC (primary sleeve pneumonectomy [pSP]) and 19 patients
were treated because of postpneumonectomy bronchial stump insufficiency or bronchial
anastomosis dehiscence (secondary sleeve pneumonectomy [sSP]). Complications occurred
in 30 patients (60%) and the 90-day mortality was 18% (n = 9). Patients with pSP had an estimated overall survival of 39.6 months, compared
to estimated overall survival for patients after sSP of 24.5 months (p = 0.01). The N status did not appear to affect outcomes.
Conclusion Carinal sleeve resection with pneumonectomy is a feasible procedure with limited
morbidity and mortality. This procedure is a reasonable therapeutic option for patients
with locally advanced central NSCLC after mandatory patient selection.
Keywords
sleeve pneumonectomy - carinal resection - non-small-cell lung cancer - trachea
